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Sonar Provider Contract Request Form If you are not currently a contracted provider with Molina Healthcare of Wisconsin, Inc. and are interested in joining our network of quality health care providers,

How to fill out non-par provider contract request

How to fill out a non-par provider contract request:

1. Begin by obtaining the non-par provider contract request form. This can typically be found on the website of your insurance provider or by contacting their customer service.
2. Fill out the basic information section of the form, which usually includes your name, contact information, and any relevant identification or provider numbers.
3. Provide details about your practice and specialties. This may include information such as your clinic's name, address, and the types of services you offer.
4. Indicate whether you are an individual provider or part of a group practice. If you are part of a group, you may need to provide additional details about the organization.
5. Specify the effective date for the non-par provider contract. This is the date from which you wish the contract to start.
6. Review and understand the terms and conditions of the contract. Pay attention to any specific requirements or limitations outlined in the document.
7. If necessary, attach any supporting documentation or credentials that may be required by the insurance provider. This could include copies of your medical license, board certifications, or malpractice insurance.
8. Sign and date the non-par provider contract request form. Ensure that you have completed all the required fields accurately before submission.
9. Finally, submit the form as instructed by the insurance provider. This may involve mailing or faxing it to the designated department. Keep a copy of the completed form for your records.

Who needs a non-par provider contract request?

1. Healthcare professionals who are not participating providers (non-par) in an insurance network may need to submit a non-par provider contract request. This can include physicians, dentists, psychologists, and other medical practitioners.
2. Non-par providers may choose to submit a contract request in order to establish a formal agreement with an insurance provider. This can allow them to receive reimbursement for services provided to patients with insurance coverage.
3. Private practice owners or independent healthcare providers who are not already contracted with an insurance network may need a non-par provider contract to access a broader patient base and expand their practice.

It is important to note that each insurance provider may have specific requirements and processes for submitting a non-par provider contract request. It is recommended to consult the provider's website or reach out to their customer service for detailed instructions.

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What is non-par provider contract request?

Non-par provider contract request is a request for a provider who is not participating in a particular insurance network to be considered for a contract.

Who is required to file non-par provider contract request?

Any healthcare provider who wants to be considered for a contract with an insurance network in which they are not currently participating.

How to fill out non-par provider contract request?

Non-par provider contract requests typically require the provider to submit information about their practice, credentials, services offered, and desired contract terms.

What is the purpose of non-par provider contract request?

The purpose of non-par provider contract request is to request to be considered for a contract with an insurance network where the provider is not already participating.

What information must be reported on non-par provider contract request?

Non-par provider contract request may require information such as provider name, contact information, services offered, billing practices, and desired contract terms.