Credentialing, Create a Group – Sign Up

Thank you for your interest in our lactation provider Credentialing, Group Creation. Credentialing for a Group is perfect for you if you are managing a group of providers who are all in network with insurance, and you want to bill under one NPI for ease of accounting and payments. For this service each provider in the group must be fully credentialed and contracted with insurance.  Credentialing for a Group creates a group practice with the databases and insurance companies you choose. (You’ll be able to discuss specifics with your credentialing specialist.)

Please complete the contact information below with the primary provider responsible for the group. After submitting this information, you’ll be directed to a page to complete payment.

Primary Contact Information

Please enter the contact information of the primary person responsible for the group.  This is usually the owner of the group practice or a person designated to handle credentialing tasks on behalf of the group.  This person will be the primary contact responsible for payment and for this service and receive all email and phone contact with questions and/or service updates, unless direct contact with the provider is necessary.

Primary Contact Name:*
Organization Name:
Primary Contact E-mail:*
Primary Contact Phone:*
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Fax:
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Select Product:*
Payment
After completion of all required fields, agreeing to our terms, and upon clicking, "Submit and continue to payment," you will be directed to PayPal to complete payment processing.  Once this form AND payment are completed, you'll receive an email from us with further instructions for moving forward with this credentialing service, along with contact information for your assigned Credentialer.  If you have any questions or concerns throughout this process, please feel free to email [email protected].
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