Network access

Find network access filing requirements, forms and instructions.

Instructions and frequently asked questions

• Network Access Report Submission instructions (updated 3-4-19) (PDF, 583.07 KB)
• Urban Counties (updated 4-28-2021) (Excel, 14.98 KB)
• Frequently Asked Questions (updated 3-4-19) (PDF, 124.22 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, 168.83 KB)
• Network Enrollment Form B Report (updated 12-1-2020) (Excel, 272.31 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 11/16/2021 using the NPPES file from 11/9/2021.

• ​ Provider Network Form A instructions (updated 3-31-2020) (PDF, 676.25 KB)
• ​ Provider Network Form A FAQ (updated 3-4-19) (PDF, 306.62 KB)

Analyst checklists

• Network Access Reports (updated 3-4-19) (PDF, 288.97 KB)
• Provider and Facility Agreements (updated 8-3-21) (Word, 65.92 KB)
• Single Case Provider and Facility Agreements (updated 8-3-21) (Word, 58.43 KB)

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• Network Access Portal