Get Bmc Healthnet Plan Provider Data Form - Bmchp

Filling out the BMC HealthNet Plan Provider Data Form is an essential step for providers to ensure proper credentialing. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately online.

Follow the steps to fill out the BMC HealthNet Plan Provider Data Form seamlessly.

1. Press the ‘Get Form’ button to acquire the form and access it in your preferred editing tool.
2. Begin with the provider demographics section. Enter the provider's full name, indicating whether they are a primary care physician (PCP), specialist, or hospital-based provider. Also, fill in the provider title and today's date.
3. Provide the mailing contact name and email address for any follow-up communications regarding the form.
4. If the provider is hospital-based, list any additional hospital affiliations and complete the abbreviated credentialing form as required.
5. Indicate the effective date of privileges and detail any collaborating physicians, including PAs and NPs.
6. Answer the accessibility to services questions regarding American Sign Language, minority-owned business status, and whether the provider wants to be listed in the BMC HealthNet Plan Provider Directory.
7. Respond to each question concerning the office's handicap accessibility. Check the applicable options for public transportation access, handicap parking, wheelchair ramps, elevators, accessible bathrooms, Braille signs, and TTY/TDD services.
8. If the provider is a PCP, indicate whether they serve any special populations by responding to each relevant category such as children/adolescents, patients with disabilities, or geriatric members.
9. Compile any additional documents that need to be submitted with the form, including the participating provider agreement if not contracted, the W-9 form, HCAS enrollment form, abbreviated credentialing form, and extra practice addresses if necessary.
10. Upon completion, review all entries for accuracy. You may then save your changes, download a copy for your records, print the form, or share it as required.

Start filling out your BMC HealthNet Plan Provider Data Form online today to ensure prompt credentialing.