Get Group Provider Application - E4 Health

Completing the Group Provider Application with E4 Health online is an essential step for your group to become a network provider and support clients' needs effectively. Follow these steps to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the application.

1. Press the ‘Get Form’ button to obtain the application and open it in your designated editor.
2. Begin by providing the main contact information for the Employee Assistance Program (EAP), including the first name, last name, phone number, and email of the primary contact.
3. Input the practice information by filling out the practice name, National Provider Identifier (NPI), Employer Identification Number (EIN) or Social Security Number (SSN), and the mailing address details, including city, state, and zip code.
4. Indicate the hours of operation for your practice to facilitate the scheduling of appointments.
5. Complete the payment information section with the mailing address for payment processing.
6. Select the area(s) of expertise your group is experienced in by marking the appropriate boxes provided in the application.
7. Identify the population served by your group by selecting the relevant age groups included in the options.
8. List any additional languages spoken by your group's members to enhance accessibility for clients.
9. Complete the insurance plan information section, selecting all applicable insurance providers your practice accepts.
10. Fill out the additional questions related to account services and malpractice insurance, ensuring to provide accurate and up-to-date information.
11. If you have multiple providers, attach the additional provider information as required, ensuring to repeat the necessary steps for each individual provider.
12. Review all information entered for accuracy, then save your changes, and email the completed application to provider.relations@e4healthcare.com or fax it to 972-717-7929.

Start your application process online to join E4 Health as a trusted provider.