Network access

Find network access filing requirements, forms and instructions.

Instructions and frequently asked questions 

• Frequently asked questions (PDF, 163.73 KB)
• Network Access Report Submission instructions (updated 12-19-17) (PDF, 559.25 KB)
• Urban Counties (updated 12-19-2017) (PDF, 31.77 KB)

Templates

• Access plan cover sheet (Word, 19.24 KB)
• ​Alternative Access Delivery Request (AADR) – Request Form (PDF, 15.62 KB)

• Form C - AADR (Alternative Access Delivery Request Form C) (updated 4-9-18) (PDF, 846.98 KB)
• Network Enrollment Form B Report (updated 12-19-2017) (Excel, 175.53 KB)
• Provider Network Form A - AADR (Excel, 16.69 KB)

Provider Network Form A

Note: The Provider Network Form A's National Plan and Provider Enumeration System (NPPES) data was loaded on 5/24/18 using the NPPES file from 5/15/18.

• ​ Provider Network Form A instructions (updated 5-3-18) (PDF, 627.09 KB)
• ​Provider Network Form A FAQ (updated 12-19-17) (PDF, 851.29 KB)

Analyst checklists

• Network Access Reports (PDF, 237.98 KB)
• Provider and Facility Agreements (updated 4-17-18) (PDF, 168.93 KB)

Login

• Network Access Portal