MI McLaren Health Plan Provider Information Form 2014 free printable template

PROVIDER INFORMATION SHEET GENERAL INFORMATION CASH # BOARD CERTIFIED YES OR NO Board Certified Specialty: PROVIDER S SOCIAL SECURITY NUMBER Please Submit Current W-9 Last Name First Name Practice/Group

How to fill out provider information sheet

How to fill out MI McLaren Health Plan Provider Information Form

1. Obtain the MI McLaren Health Plan Provider Information Form from the official website or through your network.
2. Fill in the provider's basic information including name, address, and contact details.
3. Provide the National Provider Identifier (NPI) number.
4. Include details about the practice or organization, such as Tax Identification Number (TIN) and type of service providers.
5. Complete the sections regarding billing and payment preferences.
6. Review all the information for accuracy.
7. Sign and date the form where required.
8. Submit the completed form as per the instructions provided, either electronically or via mail.

Who needs MI McLaren Health Plan Provider Information Form?

1. Healthcare providers looking to join the MI McLaren Health Plan network.
2. Existing providers that need to update their practice or contact information.
3. New providers who will be billing MI McLaren Health Plan for services rendered.

People Also Ask about

What is the Healthy Michigan plan?

The Healthy Michigan Plan is a managed care health plan contracted with the state of Michigan. Blue Cross Complete of Michigan administers Healthy Michigan Plan benefits to eligible members.

What is the phone number for McLaren Healthy Michigan Group?

For questions regarding policy and coverage information, call: 1-888-327-0671.

Is McLaren HMP Medicaid?

With McLaren Health Plan Medicaid, you get doctor visits, prescription drugs, well visits, children's health services and much more. Free transportation is offered to and from medical visits. Eligibility is determined by local Department of Human Services (DHS) offices.

What is the payer ID for McLaren health plan?

McLaren Health Advantage's EDI payer ID is 38338. Contracted providers are paid ing to the McLaren Health Advantage fee schedule.

What is the phone number for McLaren Oakland Hospital billing?

Please direct billing questions to: Patient Accounting 989-894-8888 or 888-899-1077. Office hours are Monday - Friday 8 a.m. - 4 p.m.

What is the payer ID for McLaren Health Plan Medicaid?

McLaren Health Advantage's EDI payer ID is 38338. Contracted providers are paid ing to the McLaren Health Advantage fee schedule.

Is Healthy Michigan plan Medicaid or Medicare?

The Healthy Michigan Plan is a Medicaid health care program through the Michigan Department of Health and Human Services (MDHHS).

What's the difference between Medicaid and Healthy Michigan plan?

The Healthy Michigan Plan is a type of Medicaid coverage. Medicaid is a partnership between federal and state governments. They work together to provide coverage. The federal government gives rules and resources.

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What is MI McLaren Health Plan Provider Information Form?

The MI McLaren Health Plan Provider Information Form is a document used by healthcare providers to provide necessary information to the McLaren Health Plan for contracting and credentialing purposes.

Who is required to file MI McLaren Health Plan Provider Information Form?

Healthcare providers and organizations that wish to participate in the McLaren Health Plan network are required to file the MI McLaren Health Plan Provider Information Form.

How to fill out MI McLaren Health Plan Provider Information Form?

To fill out the form, providers should complete all sections accurately, providing relevant personal and professional information, and submit it to the designated McLaren Health Plan department either electronically or via mail.

What is the purpose of MI McLaren Health Plan Provider Information Form?

The purpose of the form is to collect essential data about healthcare providers for the purposes of credentialing, ensuring compliance with network standards, and facilitating reimbursement processes.

What information must be reported on MI McLaren Health Plan Provider Information Form?

The form requires reporting of provider details such as name, address, contact information, licensing information, specialty, insurance details, and any relevant affiliations or malpractice history.