Get the free HMSA Facility/Ancillary Facility Initial Credentialing Application Form
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Este formulario está diseñado para la solicitud de credenciales iniciales de instalaciones y servicios auxiliares que deseen participar en programas de HMSA. Incluye campos para información legal
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How to fill out hmsa facilityancillary facility initial
How to fill out HMSA Facility/Ancillary Facility Initial Credentialing Application Form
01
Obtain the HMSA Facility/Ancillary Facility Initial Credentialing Application Form from the HMSA website or your HMSA representative.
02
Fill out the facility name and address in the designated sections.
03
Provide the National Provider Identifier (NPI) number where required.
04
Complete sections regarding facility ownership and governance.
05
Detail services provided by the facility, including specialties.
06
Include details about facility staff qualifications and credentials.
07
Attach necessary documentation, such as licenses and certifications.
08
Review the application for completeness and accuracy.
09
Sign and date the application form.
10
Submit the application to the appropriate HMSA credentialing department.
Who needs HMSA Facility/Ancillary Facility Initial Credentialing Application Form?
01
Healthcare facilities seeking to be credentialed by HMSA.
02
Ancillary facilities that intend to offer services to HMSA members.
03
Organizations looking to ensure compliance with HMSA network requirements.
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What is HMSA Facility/Ancillary Facility Initial Credentialing Application Form?
The HMSA Facility/Ancillary Facility Initial Credentialing Application Form is a document used to collect essential information from healthcare facilities and ancillary services seeking credentialing with HMSA (Hawaii Medical Service Association).
Who is required to file HMSA Facility/Ancillary Facility Initial Credentialing Application Form?
Healthcare facilities and ancillary providers that wish to participate in HMSA networks and provide services to HMSA members are required to file the HMSA Facility/Ancillary Facility Initial Credentialing Application Form.
How to fill out HMSA Facility/Ancillary Facility Initial Credentialing Application Form?
To fill out the HMSA Facility/Ancillary Facility Initial Credentialing Application Form, applicants should carefully read the instructions, provide accurate and complete information in all sections, attach required documents, and submit the application to HMSA as per the guidelines provided.
What is the purpose of HMSA Facility/Ancillary Facility Initial Credentialing Application Form?
The purpose of the HMSA Facility/Ancillary Facility Initial Credentialing Application Form is to evaluate the qualifications, capabilities, and compliance of healthcare facilities and ancillary providers in order to ensure they meet HMSA's standards for network participation.
What information must be reported on HMSA Facility/Ancillary Facility Initial Credentialing Application Form?
The HMSA Facility/Ancillary Facility Initial Credentialing Application Form must report various information including facility details, ownership structure, licensure and accreditation status, services offered, and any relevant history of legal and regulatory compliance.
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