All new providers enrolling in the Alliance Health Provider Network should complete the full Practice Setup Packet to ensure accurate setup for payment and authorization submissions, which includes:
- Practice Profile
- Vendor Setup Packet
- Trading Partner Agreement and Connectivity Form
- ACS Portal Access Request
For our purposes, “practice” refers to the operating entity and not individual service locations.
Accessing the Setup Packet
Currently, the form must be completed online.
Save Your Progress
You may save your progress and return to the form as required until you are ready to submit.
If you need assistance in completing or submitting this form, please contact [email protected]