Get Nc Uniform Application To Participate As A Health Care Practitioner 2005-2025

The NC Uniform Application to Participate as a Health Care Practitioner is an essential document for health care providers seeking to contract with insurers in North Carolina. This guide provides detailed, step-by-step instructions to help you complete the form accurately and submit it efficiently online.

Follow the steps to complete the application successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the demographic and personal data section. Fill in your name, date of birth, place of birth, and social security number. Ensure that you provide accurate information as this will be checked for verification.
3. List your practice name and primary office address, including phone and fax numbers. Indicate if your office is handicapped accessible and whether you are accepting new patients. Repeat this for any secondary office addresses.
4. Document any other providers working alongside you, including nurse practitioners and physician assistants. Make sure to attach proof of their liability insurance if applicable.
5. Input your educational background, including medical school, internships, and residencies attended. Be specific with dates and institutions. Attach any necessary certificates.
6. Answer all professional information questions carefully. If any 'yes' responses are given, complete the attached supplemental form for elaboration.
7. Once completed, review your application for accuracy and completeness. Save your changes, and download or print the application as needed before submitting it directly to the relevant organizations.

Start completing the NC Uniform Application to Participate as a Health Care Practitioner online today!