Get Multiplan Group Cover Sheet For Practioner Applications Form

Filling out the Multiplan Group Cover Sheet for Practitioner Applications Form online can streamline your application process. This guide provides detailed steps to ensure you complete each section accurately and efficiently.

Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. In the 'Group Name' field, enter the name of the group exactly as it appears on your MultiPlan Group Contract.
3. In the 'MultiPlan Group ID #' section, input the identification number associated with your group.
4. Attach the cover sheet to each practitioner application you submit for credentialing.
5. Ensure that each application is fully completed, especially the signed Attestation/Release section, which must be dated within thirty (30) days prior to submission.
6. If the applicant is hospital-based, indicate this by checking 'Yes' in the appropriate section.
7. Gather the required supporting documents, including TIN Authorization forms if applicable, current insurance certificates, a Curriculum Vitae, and explanations for any affirmative responses to professional questions.
8. If using a Standardized State Application from specified states, make sure to include any additional required documentation.
9. Review your application to confirm complete accuracy and compliance with all requirements.
10. Once the form is complete, save your changes, download, print, or share the form as needed.

Start completing your Multiplan Group Cover Sheet for Practitioner Applications Form online today!