Get Participating Practitioner Agreement - Webcvo

Filling out the Participating Practitioner Agreement is an essential step for practitioners looking to join the Healthways WholeHealth Networks, Inc. This guide provides clear and detailed instructions to help users complete the form accurately and efficiently.

Follow the steps to complete your Participating Practitioner Agreement.

1. Click the ‘Get Form’ button to obtain the Participating Practitioner Agreement.
2. Begin filling out your personal information in the designated fields. This includes your printed name, licensed specialty, and signature.
3. Specify your discount percentage, ensuring to note that the minimum discount is 10%. If left blank, a 20% discount will be assumed.
4. Provide your primary and secondary practice location details, including address, city, state, zip code, and phone number.
5. Fill in your NPI, fax number, license number, tax ID, and license expiration date accurately.
6. Detail your malpractice insurance carrier name, limits, and expiration date.
7. Indicate your accepted payment methods, such as credit cards, cash, or checks.
8. Review all provided information for accuracy and completeness.
9. Once all fields are filled, save changes, and you may choose to download, print, or share the completed form as necessary.

Complete your Participating Practitioner Agreement online today to start serving with Healthways WholeHealth Networks.