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HealthChoice Facility Contract v1 3 HealthChoice Facility Contract application v1 3 2026
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- Click ‘Get Form’ to open the HealthChoice Facility Contract application in the editor.
- Begin by filling out the general information section, including the legal name of the facility, trade name, and CMS classification. Ensure all fields are completed accurately.
- Provide both physical and mailing addresses. The physical address is crucial for service location, while the mailing address will be used for legal notices.
- Attach required documents such as current state licenses, liability insurance face sheets, and W-9 forms. Use the attachment feature in our platform to upload these documents seamlessly.
- Review all entries for completeness and accuracy. Incomplete applications will be returned unreviewed, so double-check each section before submission.
- Once satisfied with your entries, click ‘Submit’ to send your application directly through our platform for processing.
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Related links
The intent of this Contract is to provide access to enhanced quality Medical and Dental Services, utilizing managed care components, at an affordable, 24-hour
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