Get the free HMSA Provider Application Form for Business/Facility - Hawaii ...

PACIFIC NORTHWEST PROVIDERS P.O. Box 12249 Portland, OR 97212PacificNWProviders×gmail.com 800.875.9213 FAX 503.389.1406 Application Instructions 1. Please fill out application completely, and sign

How to fill out hmsa provider application form

How to fill out hmsa provider application form

1. To fill out the HMSA provider application form, follow these steps:
2. Download the application form from the HMSA website.
3. Fill in your personal information, such as name, contact details, and social security number.
4. Provide your professional credentials, including your medical license number and any certifications.
5. Indicate the services you offer and any specializations.
6. Specify the locations where you practice or are willing to provide services.
7. Provide details of your availability and preferred schedule.
8. Include information about your malpractice insurance coverage.
9. List any affiliations or memberships with professional organizations.
10. Attach any necessary supporting documents, such as copies of your license or certifications.
11. Review the completed form for accuracy and completeness.
12. Sign and date the application form.
13. Submit the application form either online or by mail to the designated HMSA address.
14. Wait for confirmation from HMSA regarding the status of your application.

Who needs hmsa provider application form?

1. Anyone who wishes to become an HMSA provider needs to fill out the HMSA provider application form. This includes medical professionals such as doctors, nurses, therapists, and other healthcare providers who want to join the HMSA network and provide services to HMSA members. Additionally, healthcare facilities or organizations that want to become contracted providers with HMSA may also need to complete the application form.

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What is hmsa provider application form?

The HMSA provider application form is a document that healthcare providers fill out to apply to become a contracted provider with the Hawaii Medical Service Association.

Who is required to file hmsa provider application form?

Healthcare providers who wish to become contracted providers with the Hawaii Medical Service Association are required to file the HMSA provider application form.

How to fill out hmsa provider application form?

To fill out the HMSA provider application form, healthcare providers need to provide detailed information about their practice, qualifications, and agreement to follow HMSA's policies and procedures.

What is the purpose of hmsa provider application form?

The purpose of the HMSA provider application form is to gather information about healthcare providers who are interested in becoming contracted providers with the Hawaii Medical Service Association.

What information must be reported on hmsa provider application form?

The HMSA provider application form typically requires information about the provider's practice, qualifications, specialties, contact information, and agreement to comply with HMSA's policies and procedures.