Get Hi Alohacare Provider Credentialing Application 2017-2026

Completing the HI AlohaCare Provider Credentialing Application online is a crucial step in joining AlohaCare’s Provider Network. This guide will walk you through each section and field of the application to ensure that you fill it out correctly and completely.

Follow the steps to fill out the application accurately.

1. Click ‘Get Form’ button to access the HI AlohaCare Provider Credentialing Application and open it in the editor.
2. Begin by filling out the identification and demographics section. This includes selecting your provider classification, specialty, and provider type. Ensure to accurately provide your legal name, date of birth, and contact information.
3. In the provider info section, provide crucial details such as your social security number, individual NPI, and Medicaid number. Ensure all responses are complete and truthful.
4. Move on to the office information/location of practice section. Specify your practice's address and whether you are accepting new patients. Indicate if your practice complies with the Americans with Disabilities Act standards.
5. Complete the state licensure section by listing all current and previous licenses. This includes the state board that issued the licenses, their numbers, and expiration dates.
6. In the specialty/board certification section, list any certifications received from recognized certification boards, along with their details.
7. Fill out the professional education and training section with your educational background, including degrees earned and the completion dates.
8. Continue with the hospital affiliations and privileges section. Include your primary hospital affiliation and any admitting privileges held.
9. Provide your work history for the past five years, stating your office practice names, dates employed, and explanations for any employment gaps.
10. Disclose information pertaining to your health status, ensuring that you answer truthfully to questions regarding your mental and physical conditions.
11. Complete the accessibility section, detailing how you ensure 24-hour accessibility to medical services.
12. In the attestation section, affirm that the information provided is true and complete. Sign and date the application.
13. Prepare and attach all required documents, including copies of your professional license, liability insurance, and any additional certifications specified.
14. Once you have reviewed your application and attached documents, save your changes. You can then download, print, or share the completed application.

Start completing your HI AlohaCare Provider Credentialing Application online today to ensure timely processing.