Provider Onboarding
Submitter Name *
 
Submitter Email *
Provider Name *
   
Provider Email *
Provider Phone
Provider Degree *
Provider NPI *
Billing Effective Date *
Provider Office *
Employer *
NJMS Status *
NJMS Department *
Infinity Department Code(s) *
RWJBH NBIMC Infinity Division Code *
Biller Name *
Biller Phone *
Location Setup *
In order to determine if the new provider is a Hospitalist or a Hospital Based Provider, please indicate if the provider meets the following criteria:
Does practitioner practice exclusively in an inpatient setting and provide care for patients only because patients are directed to the hospital or another inpatient setting? *
Yes
No
In order to determine if the new provider is a Hospitalist or a Hospital Based Provider, please indicate if the provider meets the following criteria:
Does practitioner practice exclusively in a free-standing facility and provide care to patients only because patients are directed to that particular facility? *
Yes
No
Will Provider be in-network with NJMS Managed Care contracts by default? *
For most Providers the answer will be Yes. Some specialists may choose to be out of network by default. Further discussion may be needed with your Change Healthcare Client Manager.
Yes
No
Does the Provider bill through another Group? *
Part-time, Per Diem or Volunteer Providers may be continuing to bill through another group.
Yes
No