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PreBirth Selection FormPlease complete all fields. Fax completed form to 9374870904. You can also complete this form by calling Member Services at 18446072829 (TTY: 18007433333 or 711) or online at

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How to fill out new health partner contract

01

Review the terms and conditions of the new health partner contract.

02

Gather all necessary information and documents required for the contract.

03

Fill out the contract form accurately with the required information.

04

Review the completed contract for any errors or missing information.

05

Sign the contract where required and obtain signatures from all relevant parties.

06

Submit the completed contract to the designated health partner contact for processing.

Who needs new health partner contract?

01

Healthcare providers looking to establish a partnership with a new health partner.

02

Organizations seeking to expand their network of health partners.

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What is new health partner contract?

The new health partner contract is a document outlining the agreement between a health partner and a healthcare organization.

Who is required to file new health partner contract?

Health partners and healthcare organizations are required to file the new health partner contract.

How to fill out new health partner contract?

The new health partner contract can be filled out by providing all required information and signatures of both parties involved.

What is the purpose of new health partner contract?

The purpose of the new health partner contract is to establish the terms and conditions of the partnership between the health partner and the healthcare organization.

What information must be reported on new health partner contract?

The new health partner contract must include details of services provided, payment terms, duration of the contract, and responsibilities of each party.

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