Get the free MDwise CMS-1500 Provider Enrollment and Claims Submission - mdwise

HHW-HIPP0316 (9/13) October 2013 ICP Annual Workshop Hoosier Health wise/HIP MD wise CMS-1500 (08-05) Provider Enrollment and Claims Submission: Quick tips to avoid claim denial Exclusively serving

How to fill out mdwise cms-1500 provider enrollment

How to fill out mdwise cms-1500 provider enrollment?

Obtain the necessary forms:

1. Visit the MDwise website or contact their customer service to request the mdwise cms-1500 provider enrollment forms.
2. Alternatively, you can download the forms directly from the website and print them out.

Provide your basic information:

1. Fill in your personal information, such as your name, address, phone number, and email address.
2. Be sure to double-check the accuracy of the information provided to avoid any delays in processing.

Provide your practice information:

1. Include details about your practice, such as the name, address, contact information, and the type of services you offer.
2. If you have multiple locations, make sure to indicate each location separately.

Determine your specialty and services:

1. Indicate the specific medical specialty or specialties you specialize in.
2. Specify the services you provide, ensuring accuracy and completeness.

Provide your certification and licensing information:

1. Fill in your license numbers, certification details, and any other relevant credentials.
2. Include copies of your license and certifications as required.

Submit supporting documentation:

Attach any additional documentation required, such as proof of malpractice insurance, DEA registration, and any other relevant certifications or qualifications.

Complete the enrollment agreement:

1. Read and understand the terms and conditions outlined in the enrollment agreement.
2. Sign and date the agreement as required.

Who needs mdwise cms-1500 provider enrollment?

Healthcare providers:

Physicians, surgeons, specialists, and other healthcare professionals who wish to contract with MDwise to provide services to their members.

Medical practices and clinics:

Group practices, clinics, or healthcare facilities looking to join MDwise's network and provide services to their members.

Ancillary service providers:

Providers of ancillary services such as diagnostic imaging, laboratory testing, physical therapy, or other related services who want to become part of MDwise's network.

Healthcare organizations:

Hospitals, medical centers, or healthcare organizations that aim to establish a partnership with MDwise to offer comprehensive care options to their members.

Remember, the specific eligibility criteria and requirements for mdwise cms-1500 provider enrollment may vary, so it's important to review the instructions and guidelines provided by MDwise carefully before filling out the enrollment forms.

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