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CALL COVERAGE DESIGNATION & CREDENTIALING CONTACT INFORMATION FORM Requirements: Physician agrees to provide coverage for Members twenty-four (24) hours per day, seven (7) days per week by a network

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How to fill out call coverage agreement

01

Review the call coverage agreement document thoroughly to understand the terms and conditions.

02

Fill in your personal information including name, contact details, and professional credentials.

03

Specify your availability for call coverage and any limitations or restrictions you may have.

04

Agree to the terms of compensation and payment for call coverage services.

05

Sign and date the document to indicate your acceptance and understanding of the call coverage agreement.

Who needs call coverage agreement?

01

Healthcare professionals such as doctors, nurses, and physician assistants who provide on-call services.

02

Hospitals, medical clinics, and healthcare facilities that require coverage for after-hours or emergency situations.

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What is call coverage agreement?

A call coverage agreement is a contract between physicians that outlines responsibilities for providing coverage for each other.

Who is required to file call coverage agreement?

Physicians who will be sharing call coverage responsibilities are required to file the agreement.

How to fill out call coverage agreement?

Call coverage agreements can be filled out by outlining the responsibilities of each physician, including the schedule and terms of coverage.

What is the purpose of call coverage agreement?

The purpose of a call coverage agreement is to ensure that patients have access to medical care at all times, even when a physician is unavailable.

What information must be reported on call coverage agreement?

Information such as the names of the physicians involved, the dates and times for coverage, and any compensation arrangements must be reported on the agreement.

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