Get Map-811 Application Form Revised - Provider Alert - Passport ...

Filling out the MAP-811 Application Form Revised is a critical step for providers seeking credentialing with KyHealth Choices. This guide will walk you through each section of the form to ensure a smooth online submission process.

Follow the steps to complete the MAP-811 Application Form online.

1. Click ‘Get Form’ button to access the MAP-811 Application Form and open it for filling.
2. Begin with the applicant's information section. Enter your full name, address, contact details, and National Provider Identifier (NPI) if applicable.
3. Proceed to the provider type section. Select the type of provider you are from the given options such as Individual or Non-Credentialed, ensuring your choice aligns with your practice.
4. Complete the background and ownership disclosure section. This may require details about ownership interests and affiliations. Ensure all responses are accurate and complete.
5. Fill out the certification and signature section. Read the statements carefully, ensuring you understand the commitments before signing your name.
6. Review all provided information for accuracy. Make necessary edits if any fields are incomplete or incorrect.
7. Once you have thoroughly reviewed the form, save your changes. You may download the completed form, print it, or share it as needed.

Get started on your online application today by filling out the MAP-811 form.