Get Participating Practitioner Agreement

Completing the Participating Practitioner Agreement online is a straightforward process that allows practitioners to join the Healthways WholeHealth Network. This guide will walk you through each section of the form, ensuring you understand the required information and how to submit it efficiently.

Follow the steps to complete your agreement smoothly.

1. Click the ‘Get Form’ button to download and access the Participating Practitioner Agreement. This ensures you have the correct form before starting the completion process.
2. In the first section, fill in your printed name as the Practitioner and your licensed specialty or specialties. This verifies your identity and qualifications.
3. Affirm your agreement to the terms and conditions by signing the form. Make sure to also include the date of your signature.
4. Provide your primary and secondary practice locations. Fill in the address, city, state, zip, and phone number for each. This information is crucial for establishing your practice identity in the network.
5. Complete your NPI (National Provider Identifier) and tax ID numbers. These identifiers are necessary for billing and insurance purposes.
6. Indicate your malpractice carrier and coverage limits, including the expiration date for your malpractice insurance. This step is essential for compliance and to protect both you and your patients.
7. Detail your average fee range and the accepted payment methods. Include information about credit cards, cash, personal checks, and debit cards.
8. Finally, review all the information provided for accuracy before saving changes. If everything is correct, you can download a copy for your records or print it for future use.

Complete your Participating Practitioner Agreement online today to join the Healthways WholeHealth Network smoothly.