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PARTICIPATING PROVIDER PROFILE ADDENDUM (All information is required for CAPS enrollment) Updated/Renewal New Pharmacy DBA Name: Corporate Name: Street Address City State Zip Mailing Address City
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How to fill out participating provider profile addendum

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How to fill out participating provider profile addendum

01
Step 1: Log in to your account on the participating provider portal.
02
Step 2: Go to the 'Profile' section and click on 'Addendum'.
03
Step 3: Fill out the required fields such as your contact information, practice details, and any additional information requested.
04
Step 4: Review the addendum thoroughly to ensure all the information provided is accurate.
05
Step 5: Click on the 'Submit' button to save and submit the addendum.
06
Step 6: Wait for confirmation from the provider network that your addendum has been processed successfully.

Who needs participating provider profile addendum?

01
Healthcare professionals who are part of a participating provider network need to fill out the participating provider profile addendum.
02
New providers joining a network, existing providers making updates to their information, or providers undergoing re-credentialing may need to complete the addendum.
03
It is important for providers to update their profiles regularly to ensure accurate and up-to-date information is available for patients and insurance companies.
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The participating provider profile addendum is a document that contains additional information about a healthcare provider's participation in a specific network or plan.
Healthcare providers who are part of a particular network or plan are required to file the participating provider profile addendum.
The participating provider profile addendum can be filled out online through the network or plan's portal, or it can be submitted via mail or email.
The purpose of the participating provider profile addendum is to provide additional information about the healthcare provider's services, specialties, and contact information.
The participating provider profile addendum typically includes information such as the provider's name, contact details, services offered, specialties, and any additional certifications or accreditations.
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Relevant keywords

California LLC PSAO NCPDP NPI Nabors CPhT GPO APNS Stacy DBA APCI pharmacies increments applicable ADDENDUM enrollment Prevention undergone Medicare Medicaid electronically affiliated Renewal profiles Expiration format deduct Audit Comprehensive Updated

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