Get Provider Login Access Form - Healthplus Of Michigan - Healthplus

The Provider Login Access Form is essential for practitioners seeking access to various HealthPlus online services. This guide provides a clear, step-by-step approach to help users accurately complete the form and ensure timely access.

Follow the steps to successfully complete the Provider Login Access Form.

1. Click the ‘Get Form’ button to obtain the form and access it for filing.
2. Fill in the required user information, including first name, last name, username (if current), position, office phone number, and office email address. Ensure all fields marked with an asterisk (*) are completed.
3. In the 'Provider Information' section, list the health providers associated with the user. Enter the provider name, HealthPlus ID number, individual NPI number, and tax ID. Repeat this for each provider being added, ensuring the information is accurate.
4. Select the access requested by checking all applicable options, such as Provider Service Center or Referral Submission. Specify the request type and user type clearly.
5. If the user needs access for more than six physicians, continue the list on a separate sheet and attach it to the form.
6. Review the completed form for accuracy. Once all sections are filled out correctly, you can choose to save changes, download, print, or share the filled form as necessary.
7. Submit the completed form by mailing it to the EDI Coordinator, faxing it to 810.230.2289, or emailing it to edicoordinator@healthplus.org. Make sure to keep a copy for your records.

Complete your Provider Login Access Form online today to ensure seamless access to HealthPlus services.