Get Plot Account

This guide provides a comprehensive overview of the Plot Account, detailing each component and offering step-by-step instructions for users to complete the online form accurately. It aims to assist all users, including those with minimal legal experience, in understanding the requirements for submission.

Follow the steps to successfully complete the Plot Account online.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin filling out the form by providing all required information. Ensure that all entries are legible and that the application is filled out in its entirety. Use clear and concise language while typing or printing responses.
3. Include all necessary supporting documents. Make sure to attach a copy of your Washington State Operational License, any applicable State/Federal Licensures, accreditation or certification documents, proof of liability coverage, and any other items specified in the instructions.
4. Complete the sections regarding ownership and management by providing the names, titles, and contact information for the President/CEO, Vice President, CFO, Medical Director, and any relevant details about the organization.
5. Fill out the billing address section to designate who will receive communications and payments. Include the pay-to address, contact person, phone number, and email address.
6. Respond to the questions about office hours and service offerings. Indicate the days of operation and whether you accept new patients. Provide information about any age restrictions related to your practice.
7. Detail any affiliations with other health care organizations and acknowledge the diagnostic imaging and laboratory services you may provide, answering all questions accurately.
8. Complete sections regarding insurance coverage, accreditation and certification types, and any sanctions or disciplinary actions. Be truthful and thorough in your responses.
9. Review the Provider Responsibility Statement and the Statement of Application/Authorization for Release of Information. Ensure you understand the responsibilities outlined and complete the necessary signatory fields.
10. Once every section is filled out, save your changes. You may then download or print the form for your records, or prepare it for submission.

Start completing your Plot Account online today for a smoother credentialing process.