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  Join Our Network

Thank you for your interest in joining the CareCentrix provider network!

As a participating provider with us, you will enjoy a number of benefits:
  • Diversify your revenue base by gaining access to patients insured through our national client base
  • Electronic tools to make working with us simple
    • Electronic claims submission
    • Provider Portal for you to submit authorization, re-authorization, and add-on requests, in addition to claim and authorization status lookup features!
In order to join the CareCentrix provider network, we ask that you complete the questionnaire below, and upon submission, a member of our Network team will reach out to you for next steps.
 
*Provider Type:
*Provider Agency Name:
PROVIDER DEMOGRAPHICS
*City:
*State:
*Service Area: (counties or states covered)
*Are you a licensed home health agency or RSA?
*If applicable, do you have a Certificate of Need (CON)?
ACCREDITATION STATUS:
*CMS-Certified IDTF
*User a Type III Device?
*Accreditation
*Interpretations by a Board-certified MD?
*Medicare:
*Medicaid:
*Accreditation:
*State Department of Health Survey?
*Do you provide pediatric services?
CONTACT INFORMATION:
*Name:
*Email:
*Phone:
*Taxpayer Identification Number (TIN)
 
COMPLETE W-9 INFORMATION:
Upload W9 Form Or Fill W9 form data.
 
  
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