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This document outlines the agreement between Blue Cross Blue Shield of Michigan and the providers participating in the mental health and substance abuse managed care program, detailing responsibilities,
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How to fill out professional provider participation agreement
How to fill out Professional Provider Participation Agreement
01
Begin by reading the entire Professional Provider Participation Agreement to understand the terms and conditions.
02
Write your full legal name in the designated section at the top of the agreement.
03
Fill in your professional title or credentials that validate your role as a provider.
04
Provide your contact information, including phone number, email address, and office address.
05
Indicate your National Provider Identifier (NPI) number where required.
06
Review the sections related to reimbursement rates and payment terms carefully.
07
Sign and date the agreement at the bottom, confirming your acceptance of the terms.
Who needs Professional Provider Participation Agreement?
01
Healthcare providers including doctors, physical therapists, and mental health professionals who wish to participate in a specific insurance network.
02
Organizations seeking to contract with providers for patient care services.
03
Providers looking to receive reimbursements for services rendered under a particular insurance plan.
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What is Professional Provider Participation Agreement?
The Professional Provider Participation Agreement is a contract between healthcare providers and insurance companies that outlines the terms and conditions under which the providers will deliver services to patients enrolled in the insurance plan.
Who is required to file Professional Provider Participation Agreement?
Healthcare providers, including physicians, specialists, and other licensed professionals who wish to participate in an insurance network must file a Professional Provider Participation Agreement.
How to fill out Professional Provider Participation Agreement?
To fill out the Professional Provider Participation Agreement, providers should complete all required fields including personal and practice information, licensing details, and any specific information pertaining to the insurance network’s requirements.
What is the purpose of Professional Provider Participation Agreement?
The purpose of the Professional Provider Participation Agreement is to establish a formal relationship between providers and insurance companies, ensuring that both parties understand their rights and obligations, thereby facilitating patient access to covered services.
What information must be reported on Professional Provider Participation Agreement?
The information that must be reported on a Professional Provider Participation Agreement typically includes provider identification details, practice address, tax identification number, state license information, insurance specialties, and any previous disciplinary actions or affiliations.
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