In order to process a change of ownership for a Hospital and/or Ancillary Provider, the Consent to Assignment of Provider Contracts Form must be filled out by the seller of the business and signed by both the seller and purchaser. Once completed, email both the original signed copy along with the new Proof of Liability Insurance, new W-9, 147C IRS Letter and NPI letter or email (if changed) to your Network Management Consultant. Contact your Network Management Consultant with questions.
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