Facility Credentialing – Client Discovery Form
Facilities - DME, ASC, Home Health, Imaging Center, Laboratory, Therapy, Urgent Care & Other Facility-Based Providers
This form focuses on gathering information on existing billing operations, transition readiness, A/R, denials, reporting, and ongoing revenue-cycle support.
EHR/PM software, clearinghouse, payer portal access, and active payer enrollments are expected to be already established.
• Complete every applicable field. Select only services currently provided or planned.
• Upload supporting documents through the secure upload fields. Do not email protected or sensitive documents.
• Items marked “if applicable” may not apply to every provider or practice. Upload documentation through the secure portal only.
Facility Discovery Form Submitted
Thank you for completing the application. We have received your submission and are currently reviewing it. We will contact you shortly with the next steps in your onboarding process. Thank you, and we look forward to working with you.
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