AvMed Credentialing Application 2011 free printable template

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. PERSONAL IDENTIFICATION DATA Last Name: Date of Birth: Please list all other legal

How to fill out AvMed Credentialing Application

How to fill out AvMed Credentialing Application

1. Gather all necessary personal and professional information, including your medical license, educational background, and work history.
2. Download the AvMed Credentialing Application from their official website or obtain a physical copy.
3. Fill out your personal details accurately, including your full name, contact information, and social security number.
4. Provide your educational information, including schools attended, degrees earned, and dates of attendance.
5. List your professional experience, including previous employment and positions held, along with start and end dates.
6. Include any relevant certifications, specialties, and professional memberships.
7. Disclose any malpractice history, disciplinary actions, or other legal issues.
8. Sign and date the application to certify that the information provided is true and complete.
9. Submit the completed application along with any required supporting documents to the designated AvMed office.

Who needs AvMed Credentialing Application?

1. Healthcare professionals such as doctors, nurse practitioners, and specialists seeking to join AvMed's network.
2. Practitioners looking to provide services to patients covered by AvMed insurance plans.
3. Organizations or practices that want to establish a contractual relationship with AvMed.

People Also Ask about

Is AvMed only in Florida?

We're one of Florida's oldest and largest not-for-profit health plans, providing Medicare Advantage coverage in numerous counties including Miami-Dade, Broward, Palm Beach and Orange, Individual and Family coverage in numerous counties including Miami-Dade, Broward, Palm Beach and Alachua, and coverage for Employer

What is the payer ID for AvMed?

Institutional Payer ID: 12k89 clearinghouse.

What is the grace period for AvMed?

There is a grace period of three months for all monthly premium payments after the initial premium payment.

Which year did AvMed first provide Medicare coverage?

1982. Contracted with Health Care Financing Administration to provide Medicare coverage.

Does AvMed HMO require authorization?

Prior Authorization and Notification Process Authorizations processed by AvMed must be requested on an Authorization Request and submitted via the web or via fax. Urgent and Emergent requests may be submitted via our new prior-authorization page on the provider portal, but may also be handled telephonically or via fax.

What is the timely filing limit for AvMed provider?

Claims must be submitted and received by AvMed within 12 months after the service is provided to be eligible for benefits.

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What is AvMed Credentialing Application?

The AvMed Credentialing Application is a formal process used by AvMed to assess and verify the qualifications, experience, and fitness of healthcare providers who wish to join their network.

Who is required to file AvMed Credentialing Application?

Healthcare providers, including physicians, specialists, nurse practitioners, and other allied health professionals seeking to participate in AvMed's network are required to file the AvMed Credentialing Application.

How to fill out AvMed Credentialing Application?

To fill out the AvMed Credentialing Application, applicants must provide accurate personal and professional information, including their education, training, work history, licenses, certifications, malpractice history, and any disciplinary actions, following the provided guidelines.

What is the purpose of AvMed Credentialing Application?

The purpose of the AvMed Credentialing Application is to ensure that applicants meet the necessary standards of care, maintain quality healthcare services, and comply with legal and regulatory requirements before they are allowed to treat patients under the AvMed network.

What information must be reported on AvMed Credentialing Application?

The AvMed Credentialing Application requires reporting information such as personal identification details, professional qualifications, educational background, work history, licensing and certification details, malpractice claims, and any disciplinary actions or criminal history.