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POLICIES AND PROCEDURESPolicy #: 3004025 Lead Department: Provider Services Title: Provider Screening and Enrollment Process Original Date: 12×6/2017 Policy Hub Approval Date: 01×13/2020 Approved
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To fill out the wwwccah-allianceorgproviderspdfspm300-4025 - provider screening form, follow these steps:
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Individuals or organizations who wish to become providers for CCAH (Cross Community Alliance Health) need to undergo provider screening by filling out the wwwccah-allianceorgproviderspdfspm300-4025 form. This form is required for those seeking to offer their services as providers within the CCAH network.
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The provider screening form is a document used to collect information about healthcare providers.
All healthcare providers participating in the program are required to file the provider screening form.
The form can be filled out online or manually, following the instructions provided by the program.
The purpose of the provider screening form is to ensure the qualifications and credentials of healthcare providers.
Providers must report their personal information, qualifications, licenses, certifications, and any criminal history.
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