Get Online Facility Location Add Form U Care

Completing the Online Facility Location Add Form U Care is essential for registering a new facility location. This guide provides clear, step-by-step instructions on how to navigate and fill out the form accurately.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by answering the question, 'Are you a contracted provider?' with 'Yes' or 'No' in the contact information section.
3. Fill in the 'Completed By' field with your name, include your title, and provide your phone number.
4. In the main facility information section, enter the facility name, facility physical address, city, state, ZIP code, phone number, and tax ID number.
5. Proceed to the new location information section. Enter the effective date of the new location, new facility name, new facility physical address, city, state, ZIP code, phone number, tax ID number, a specialty, and practitioner demographic information such as last name, first name, specialty, NPI, and practitioner effective date.
6. Complete the signature section with your W9 signature and ensure that all required fields are filled out.
7. If applicable, fill in the optional fields for billing/payment information, which may include fax number, email address for confirmation, and the name and contact information of the contract manager.
8. Select or complete additional fields such as whether the new location is considered a primary care clinic, where you have hospital privileges, any special restrictions, available languages other than English, office hours, and urgent care hours if applicable.
9. Once all sections are completed, review the form for accuracy. Save changes, download a copy, print it out, or share the completed document as necessary.

Complete your documents online and ensure a smooth registration process.