Get Epiccare Link Ssm

Filling out the Epiccare Link Ssm form is a straightforward process that requires attention to detail. This guide will help you through each section of the form, ensuring that all necessary information is provided accurately.

Follow the steps to complete the Epiccare Link Ssm form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering your group or organization name in the corresponding field at the top of the form.
3. Fill in the primary office address, including the street address, city, state, and zip code.
4. Provide the name of the primary office contact person, followed by their title.
5. Input the office contact's phone number and fax number in the designated fields.
6. List all providers in your group or organization by entering their last name, first name, and middle initial.
7. Additionally, include the office manager or contact person’s name, their title, NPI number, phone number, and email address.
8. Next, list all EpicCare Link users who require access. For each user, record their last name, first name, middle initial, title, last four digits of their Social Security Number (SSN), and email address.
9. Review all filled sections for accuracy and completeness before submission.
10. Once you are satisfied with the information entered, save your changes, download the completed form, and consider printing it for your records.
11. Finally, submit the form via email to the designated Physician Coordinators at DL-STLPhysicianCoordinators@ssmhc.com. Note that processing may take up to ten days after receipt of the form.

Start completing your Epiccare Link Ssm form online today to facilitate your access.