Get Copy Of Provider Registration Form ... - Aps Healthcare

Filling out the Copy Of PROVIDER REGISTRATION Form for APS Healthcare can be straightforward with the right guidance. This user-friendly guide provides step-by-step instructions to ensure accurate completion of the form.

Follow the steps to successfully complete the Copy Of PROVIDER REGISTRATION Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the facility name in the designated field. Make sure to type or print clearly to avoid processing delays.
3. Fill in the address section, including the address line, city, state, and zip code. Accuracy in this information is crucial for correspondence.
4. Provide the fax number and phone number where APS Healthcare can reach your facility. Ensure these numbers are current and correct.
5. Next, enter the email address for the facility. This will be used for formal communications, so select an address that you monitor regularly.
6. In the WEB Data Submission Confirmation section, check all applicable boxes regarding data entry preferences for prior authorization.
7. Designate a provider's authorized APS data contact by filling out their first name, middle initial, and last name.
8. Provide the mailing address, phone, and fax number for the data contact to ensure smooth communications.
9. Enter the data contact’s email address, ensuring it is one that will be frequently checked for updates and correspondence.
10. Have the data contact provide their signature in the designated field to confirm their authorization.
11. If necessary, include the email address for APS correspondence, considering collective accessibility for your practice.
12. In the authorization section, read carefully and provide confirmation of the data contact's representation by signing where requested.
13. Indicate the CEO or owner’s first name, middle initial, and last name, followed by their signature to complete the form.
14. Finally, submit the completed form to APS-WV I.S. at the provided address or fax number. Consider keeping a copy for your records.

Complete and submit your provider registration form online to ensure your facility's efficient participation with APS Healthcare.