To expedite the credentialing process, we ask that you provide us with your digital signature. It will only be used for completing paperwork requested by insurance companies that you have asked us to work with and to enroll you and/or your clinic in.
Insurance companies regularly request that we complete provider update forms, revalidate your enrollment, etc. So there is a lot of maintnenace involved, even after you are enrolled/credentialed.
Please go to signature.imageonline.co. Using a computer (we don't recommend using a smartphone) you can draw your signature in the box and click the "download signature" button.
Please draw as "clean" and legible signature as possible.
After you have done the above, complete the form below. Upload your signature image by clicking the "Choose File" button.
"*" indicates required fields