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The 450 W State Street 4 FL Boise, Idaho 83702 (208) 3345931 2016 VACCINES FOR CHILDREN PROGRAM PROVIDER AGREEMENT FACILITY INFORMATION Facility Name: AFC Pin#: Facility Address: City: County: State:
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How to fill out new provider enrollment packet
How to fill out new provider enrollment packet
01
First, gather all the necessary information and documents required for provider enrollment. This may include personal identification, credentialing information, proof of licensure, and other related documents.
02
Carefully review the instructions provided with the new provider enrollment packet.
03
Complete each section of the packet accurately and thoroughly. Make sure to fill in all the required fields.
04
Double-check all the information provided to ensure its accuracy.
05
Attach any supporting documents as instructed in the packet.
06
Review the completed packet one last time to ensure nothing is missed or left incomplete.
07
Submit the filled-out provider enrollment packet, along with any additional required documents, to the designated authority or organization.
Who needs new provider enrollment packet?
01
Healthcare professionals who wish to become new providers for a particular healthcare organization or insurance company would need to fill out a new provider enrollment packet.
02
Individuals or groups starting their own healthcare practice or clinic and seeking to establish relationships with insurance companies or healthcare networks would also require a new provider enrollment packet.
03
Providers who are joining a new healthcare organization or transitioning to a different network may need to complete a new provider enrollment packet as part of the enrollment process.
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