Provider Registration

Provider Registration
Provider Registration

These forms are used by Doctors to register for participation in Access Gap Cover. Only the Doctor can sign on the Provider Details form. Digital Signatures must contain valid encryptions and digital stamps. It is essential that you register the associated Provider Number you are using when submitting claims. You can also use this generic form to update changes to the email, contact, postal and/or banking information. Providers are also responsible to notify AHSA of any changes to current registration information. It is very important to make sure you complete all sections of relevance on the form. Multiple Additional Practice Location forms can be used where there are more than 7 Provider Numbers to be registered.