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 4-15-2019) (PDF, 101.33 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 01-02-2019) (Excel, 277.20 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 10/20/19 using the NPPES file from 10/15/19.

• ​ Provider Network Form A instructions (updated 8-19-19) (PDF, 694.32 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 4-17-18) (PDF, 203.70 KB)

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• Network Access Portal