Facility Based Provider Onboarding Process

Do you have a new provider to add to your Facility Based group or an individual provider joining as a facility-based provider? To get assigned a provider record ID and join our networks, you will need to complete the Provider Onboarding form and be sure to include the following important or required information to prevent a delay in processing your request:

• Ensure all provider information is included on the on-boarding form and roster. Completing this information up front and accurately, in its entirety, will prevent delays in processing. Examples: Name, date of birth, NPI, social security number, gender, tax ID, etc.
• Individual providers need to provide the name of all Hospital or Ambulatory Surgery Centers that the provider services in the Hospital Admitting Privileges field(s) of the Provider Onboarding Form.
• Group Providers need to include the name of all Hospital and/or Ambulatory Surgery Centers that they service in the Hospital Privileges and/or Ambulatory Surgery Centers Privileges columns of the Provider Onboarding Roster.

For more information refer to the Verification Process for Hospital or Facility Based Providers page on the provider website.

We appreciate you participating in our networks!