Get Southcarolinapdmcentene - Absolute Total Care

Filling out the SouthCarolinaPDMcentene - Absolute Total Care form online is essential for maintaining accurate provider information. This guide offers clear, step-by-step instructions to ensure you complete the form efficiently and effectively, with all needed details.

Follow the steps to fill out the form correctly:

1. Press the ‘Get Form’ button to access the document and open it in your preferred online editor.
2. Indicate your registration status with CAQH by selecting either 'Yes' or 'No.'
3. Specify if you are a hospital-based provider that does not practice in an office setting. Choose either 'Yes' or 'No,' and if applicable, provide the locations outside the hospital.
4. Input your Tax ID number and ensure that a W9 form is attached.
5. Provide your Group Billing NPI number and attach the current Disclosure of Ownership.
6. Fill out the practice name, ensuring that all relevant details are accurate.
7. Add the email address where Absolute Total Care can contact your practice.
8. Complete your primary office street address along with suite number, city, state, county, primary telephone, primary fax, and zip code.
9. Provide credentialing contact information to ensure roster updates, including name, title, phone number, email address, and mailing address.
10. List your practice hours for each day of the week, indicating if you operate an after-hours clinic.
11. Indicate whether you have a W-9 and a Disclosure of Ownership attached by marking the appropriate checkboxes.
12. If you provide direct laboratory services, indicate your TIN and provide CLIA information, attaching your CLIA certificate or waiver if applicable.
13. Fill out any additional locations information as needed, and specify your practice hours for those locations.
14. Provide any additional information that may assist Absolute Total Care in updating your data.
15. Once all sections are completed, save your changes, and consider downloading, printing, or sharing the completed form as required.

Complete and submit your documents online to ensure accurate updates to your provider information.