AZ AHP Practitioner Data Form 2013 free printable template
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Credentialing Alliance PRACTITIONER DATA FORM PLEASE COMPLETE THIS FORM IN ITS ENTIRETY INCLUDING ATTACHMENTS SO THAT WE MAY PROCESS YOUR REQUEST. New providers receive written confirmation of their
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How to fill out AZ AHP Practitioner Data Form
01
Obtain the AZ AHP Practitioner Data Form from the official website or your institution.
02
Read the instructions carefully before starting to fill out the form.
03
Provide your personal information, including your name, contact details, and address.
04
Fill in your professional qualifications and credentials as required.
05
Detail your work experience, ensuring to include relevant roles, responsibilities, and duration.
06
Complete any sections related to continuing education or professional development.
07
Review the form for any errors or missing information before submission.
08
Submit the completed form to the relevant authority or office as instructed.
Who needs AZ AHP Practitioner Data Form?
01
Healthcare professionals applying for certification under the AZ AHP program.
02
Individuals seeking to demonstrate their qualifications and experience in advanced healthcare practice.
03
Organizations that require verification of practitioner credentials.
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You can email us at: headoffice.recruitment@alliance-healthcare.co.uk or fill in the contact form below.
What is the payer ID for Alliance Health System?
To initiate electronic claims: Utilize or inform your vendor to use the Alliance Health EDI Payer ID#: 23071.
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To initiate electronic claims: Utilize or inform your vendor to use the Alliance Health EDI Payer ID#: 23071.
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Payer Name: Health Alliance Medical Plan|Payer ID: 77950|Professional (CMS 1500)
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Provider HelpDesk: 855-759-9700 The Alliance Provider Support is available to answer provider questions about authorization, billing, claims, enrollment and credentialing, ACS, and other issues. Call 855-759-9700 Monday-Friday from 8:30 a.m.-5:15 p.m.
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What is AZ AHP Practitioner Data Form?
The AZ AHP Practitioner Data Form is a standardized document used to collect and report information about practitioners in the field of allied health professions in Arizona.
Who is required to file AZ AHP Practitioner Data Form?
Practitioners who are licensed or certified in allied health professions in Arizona are required to file the AZ AHP Practitioner Data Form.
How to fill out AZ AHP Practitioner Data Form?
To fill out the AZ AHP Practitioner Data Form, practitioners should carefully read the instructions provided, complete each section of the form accurately, and submit it to the relevant regulatory body as required.
What is the purpose of AZ AHP Practitioner Data Form?
The purpose of the AZ AHP Practitioner Data Form is to ensure that accurate and comprehensive data about allied health practitioners is collected and maintained for regulatory and workforce planning purposes.
What information must be reported on AZ AHP Practitioner Data Form?
The AZ AHP Practitioner Data Form must include information such as the practitioner's name, contact details, professional qualifications, license numbers, practice location, and any disciplinary actions taken against them.
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