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Get Hi Pr E-03 2017-2025
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How to fill out the HI PR E-03 online
The HI PR E-03 form is an essential document for medical providers seeking participation in the HWMG provider network. This guide will provide you with a clear and structured approach to filling out the form online, ensuring all necessary information is accurately submitted.
Follow the steps to successfully complete the HI PR E-03 form online.
- Click the 'Get Form' button to obtain the HI PR E-03 form and open it in your preferred editor.
- Begin with Section 1: General Practice Information. Fill in your Type 2 National Provider Identifier (NPI) number and Federal Taxpayer Identification Number.
- Enter your business name as it appears on your W-9 form. If your practice name differs from your business name, list it under 'Practice Name (DBA)'.
- Choose the type of practice by checking the appropriate box, and if selecting 'Other', specify the type.
- Provide your primary practice location information: street address, city, state, zip code, and appointment phone number. Include your office fax and email address for HWMG use only.
- Designate an office contact person along with their title and contact details.
- Indicate if the above information applies to correspondence, billing, and payments, specifying contact information if not.
- List your business's office hours for each day of the week.
- If applicable, provide information on any additional practice locations by repeating the address and contact details.
- In Section 2: Practitioner Registration, enter the required information for each practitioner associated with your practice, completing the necessary credentialing documentation as specified in the instructions.
- Certify that all information provided is accurate and true by printing the name of the authorized representative, signing, and dating the application.
- Once completed, save the changes to your form. You can then choose to download, print, or share the application as needed.
Complete your HI PR E-03 form online to ensure a smooth application process.
To properly fill out the Employee's withholding Allowance Certificate, start by entering your personal details, including Social Security number. Next, calculate the number of allowances you can claim and ensure accuracy in your selections. Implementing resources like HI PR E-03 ensures that you follow the correct procedures, making your filing straightforward and compliant.
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