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Contracted Provider Reference GuideLA4163 04/24Table of Contents Welcome Participating Contracted Provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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How to fill out contracted provider

01

Gather all necessary information such as legal business name, address, contact information, tax ID number, and credentials.

02

Contact the organization or company with which you wish to establish a contract as a provider.

03

Request a provider application form and carefully fill out all required fields.

04

Submit the completed application along with any additional requested documents (such as licenses, certifications, insurance, etc.).

05

Await approval from the organization or company, which may include a formal agreement outlining terms and conditions of the provider relationship.

Who needs contracted provider?

01

Healthcare institutions looking to expand their network of healthcare providers.

02

Insurance companies seeking to contract with healthcare providers for their policyholders.

03

Organizations or companies in need of specific services or expertise that can be provided by a contracted provider.

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What is contracted provider?

A contracted provider is an entity or individual that has entered into a formal agreement with a healthcare plan or organization to provide specific services to members.

Who is required to file contracted provider?

Healthcare plans and organizations that enter into agreements with contracted providers are typically required to file the contracted provider documentation.

How to fill out contracted provider?

To fill out contracted provider documentation, include required information such as provider name, services offered, contract terms, and any relevant identifying information according to regulatory requirements.

What is the purpose of contracted provider?

The purpose of a contracted provider framework is to ensure that there is a formal relationship between the providers and the healthcare organizations, establishing responsibilities for care delivery and payment.

What information must be reported on contracted provider?

Information that must be reported includes provider details, service types, contract dates, reimbursement rates, and compliance with applicable regulations.

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