Get Ilinkblue

Filling out the Ilinkblue online form is a streamlined process designed to assist users in managing their documentation effectively. This guide provides step-by-step instructions to ensure users can complete the form accurately and efficiently.

Follow the steps to complete the Ilinkblue online form

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by filling in your provider information, including the legal name of your institution, address, city, state, and zip code.
3. Provide your provider identifiers, such as the Federal Tax Identification Number (TIN) and the National Provider Identifier (NPI). Ensure all identifiers are current.
4. Complete the contact information fields, including the name, title, phone, email address, and fax number of the person to contact for any inquiries.
5. If applicable, complete the retail pharmacy information section with the pharmacy name and NCPDP Provider ID number.
6. Fill out the financial institution information by providing the name of your financial institution, routing number, account type, and account number.
7. In the submission section, state the reason for submission, typically indicating 'New Enrollment.'
8. Attach required documentation, such as a voided check or a bank letter certifying account details.
9. Provide the authorized signature and the printed name of the person submitting the enrollment, along with the submission date.
10. Review all completed sections for accuracy before saving the form. You can then download it, print it, or share it as required.

Complete your documentation online for seamless management.