Get the free 2013 Provider Membership Application - North Carolina Assisted ... - ncala

Park Place Professional Center 3392 Six Forks Road Raleigh, North Carolina 27609 (919) 467-2486 Fax (919) 467-5132 www.ncala.org 2013 Provider Membership Application Your membership with the North

How to fill out 2013 provider membership application

How to fill out 2013 provider membership application:

1. Start by reading the instructions provided with the application form to understand the requirements and the information needed.
2. Fill in your personal information accurately, including your full name, contact details, and any professional identification numbers required.
3. Indicate the type of provider you are applying as (e.g., doctor, dentist, therapist) and provide any necessary documentation to support your qualifications or credentials.
4. If applicable, provide information about your business or practice, such as its name, address, and contact details.
5. Complete the sections related to your insurance coverage, including providing details of the insurance company, policy number, and expiration date.
6. Include any additional information or supporting documents required, such as your professional licenses, certifications, or accreditation.
7. Review the completed application form to ensure all sections are filled out correctly and all necessary documentation is attached.
8. Sign and date the application form where indicated to certify the provided information is true and accurate.
9. Submit the completed application form along with any required fees or supporting documents to the relevant authority or organization.

Who needs 2013 provider membership application:

1. Healthcare professionals looking to join a provider network or organization may need to fill out the 2013 provider membership application.
2. Medical practitioners, such as doctors, nurses, dentists, therapists, and other allied health professionals, may require this application to become participating providers in health insurance plans or networks.
3. Providers who wish to bill and receive reimbursement directly from insurance companies or government healthcare programs may also need to complete the 2013 provider membership application.
4. Additionally, healthcare facilities, such as hospitals, clinics, and diagnostic centers, may require their affiliated providers to complete this application as part of their credentialing process or to ensure compliance with industry regulations.

For pdfFiller’s FAQs

What is provider membership application?

The provider membership application is a form that providers must submit in order to apply for membership with a particular organization.

Who is required to file provider membership application?

Providers who wish to become members of a specific organization are required to file a provider membership application.

How to fill out provider membership application?

Providers can fill out the provider membership application by following the instructions provided in the application form.

What is the purpose of provider membership application?

The purpose of the provider membership application is to gather information about the provider and assess their eligibility for membership.

What information must be reported on provider membership application?

Providers must report their contact information, qualifications, experience, and any other relevant details on the provider membership application.

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