Provider Roster Template

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Provider roster template. Universal iamhp roster template. Skip to page 9 of this guide to continue the enrollment. Advanced heart failure transplant cardiology 3 internal medicine 127 pediatric orthopaedics 2 allergy immunology 13 interventional neuroradiology 2 pediatric pulmonology 1 anesthesiology 86 maternal fetal medicine 9 pediatric surgery 10 bariatric medicine 9 neonatology 8 pediatric urology 1 breast surgery 7 nephrology 39 pediatrics 120. Blue cross community health plan utilizes the universal roster template.

Filename universaliamhprostertemplate 062118xlsx last modified 712018 90934 pm filesize 11883 kb view download. Current providers who have changes or updates to their providers status such as provider name changes office location updates new providers joining a practice etc must complete the standardized roster on a monthly basis. Please use only this template to complete your roster. Click the download provider roster template button.

If you have difficulties completing the template please reach out to your designated provider network. Can i submit provider information via paper. Provider roster worksheet section this worksheet is designed for providers to use when submitting provider rosters and updates. Mco mandated training material.

Key contact escalation documents. Please use this when submitting information for more than 10 providers. Azahp provider roster author. Resource center for providers.

Azahp provider roster add template azahp provider roster change template azahp provider roster term template. Universal provider roster template. Tubal ligation form and memo. Lynn kruk created date.

Provider roster template frequently asked questions as of september 17 2018 q. Universal provider roster template. Changes may be submitted electronically and submitted to molinas provider information management. Using this worksheet is easy and simple.

Please make sure to fill in all of the important information. You will upload it in the attachments section of the form. Care1st health plan other titles. Richard gonzales last modified by.

Iamhp border babies memo. Providers may submit changes through the roster template or by filling out the provider information update form and faxing it to 844 488 7054. Timely updates will ensure the mcos directories are current and accurate payments to providers can be made. The excel file downloads to your computer.

Complete the roster template and save it. Peer to peer review.