Step 1: Receive notification of provider accepting positions with Munson Healthcare.

Step 2: Complete Provider Request Form. Submit form to MHC-MedicalStaffServices@mhc.net.
Hospital credentialing/payer enrollment takes 90-120 days to complete once all requirements are met for full enrollment. Submit this form as soon as possible to avoid delays. 

Step 3: For employed providers, review the Provider Onboarding Checklist. This checklist is a basic overview of tasks that may need to be completed. It is recommended to download this list and add onboarding details related to the specifics of your clinic to use for future onboarding. 

Step 1: Ensure appropriate resources are available at outreach/new service location. Examples: EMR builds, billing, staffing, regulatory, and supplies. 

Step 2: Complete Provider Location Addition or Change Request Form. Submit form to MHC-MedicalStaffServices@mhc.net.

NOTE: Hospital credentialing/payer enrollment takes 90-120 days to complete once all requirements are met for full enrollment. Submit this form as soon as possible to avoid delays.

Step 1: Ensure notification has been sent to Lisa Giovanelli, Jeff Klug, Local Medical Staff Office, and Human Resources. Include the following details: Providers full name, location(s), departure date and reason for departure. 

Step 2: Complete Provider Resignation Form and submit to MHC-MedicalStaffServices@mhc.net. 

Step 3: For employed providers, review the Offboarding Checklist. This checklist is a basic overview of tasks that may need to be completed. It is recommended to download this checklist and add offboarding details related to the specifics of your clinic to use for future offboarding. 

Step 4: For employed providers, leadership should attend the "Provider Onboarding Council Meeting" to ensure that the appropriate teams are notified and the details related to the offboarding provider are captured. 

• Provider Request Form
• Provider Onboarding Checklist
• Add MPN Provider to Press Ganey
• On-Call Paging Parameters
• PA Practice Agreement
• NP, CNM Practice Agreement
• NP, CNM Prescriptive Authority Delegation
• CRNA Practice Agreement
• The Importance of Being Up to Date

• Provider Resignation Form
• Offboarding Checklist
• Remove MPN Provider from Press Ganey