Provider Network Form A

How do I file?

Step 1

Submit an electronic report by the 5th of each month. Your report must show all participating providers by network. Format your report according to Provider Network Form A (PDF, 26KB)

Step 2

Follow the FTP Filing and Format Instructions (PDF, 88KB) and submit your report in the Network Access Portal.

Note: You'll need a user ID and password. If you don't have them, call OIC Network Access at 360-725-7127.

Step 3

Use the HCP Validation (zip.exe, 138KB) program and codes. Use the following with the participating provider filings:

How to run HCPVALID program (Word, 191KB)

Note: Please use these instructions for running the HCPValid program.

See also

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