Get Wea Trust Provider Network Application

Completing the WEA Trust Provider Network Application online is an essential step for healthcare providers seeking to participate in the network. This guide provides detailed instructions to help you fill out the application accurately and efficiently.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to access the WEA Trust Provider Network Application and open it in your preferred online editor.
2. Begin with Section 1A. Provide the legal name as it appears on the W-9 form, your Federal Tax Identification Number, and the Organization/Business Practice NPI Number. Additionally, fill in your name and title, along with your contact information including phone, fax, email, and the date of submission.
3. Move on to Section 1B to supply any additional contact information. Include details for the contracting, billing, and credentialing contacts. Ensure you only enter different information if applicable.
4. Proceed to Section 2, where you will answer questions regarding your practice affiliations. Indicate whether you belong to a large provider system or an independent physician association, and list any relevant affiliations along with any outreach providers you work with.
5. Continue to Section 3, which focuses on claims submission. Indicate if you currently submit claims electronically to the WEA Trust. If not, follow the instructions for contacting Netwerkes for support.
6. In Section 4, provide detailed service location information. Enter the name, address, and contact info for each service location. If you have more than three locations, use 'Addendum A' to provide additional details.
7. Section 5 requires information about all practitioners billing under your tax ID. Document practicing specialties, names, credentials, and confirm if they are accepting new patients. If there are more than four practitioners, include this information in 'Addendum B'.
8. Before finalizing your application, make sure to attach the required W-9 form and the list of 15–20 most frequently billed codes along with their fees.
9. Once you have completed all sections and reviewed your information, save your changes, download the document, print it, or share it as necessary according to the submission options provided in the instructions.

Take the next step in your provider journey by completing your WEA Trust Provider Network Application online today.