Let’s Get Started!

We’re excited to support you! To kick off your credentialing, billing, or practice support services, we’ll need a few important forms from you. These help us gather key details and get your process moving smoothly.

Please refer to the email you received for specific instructions on which forms to complete - you may need to complete forms from multiple sections below. This ensures we have exactly what we need to get started on your services without delay. If you are unsure, please reach out directly to info@therassistfl.com for guidance before completing any forms.

Licensed Clinician & APRN Provider Demographics Form
Medical Doctor Provider Demographics Form
BCBA/ST/PT/OT Provider Demographics Form
RBT Provider Demographics Form
Business & Business Owner Demographics Form
Background Screening Clearinghouse Request Form
This form is only for providers who are enrolling in Medicaid or Medicare and NO other insurance plans. If you are also enrolling in commercial insurance plans, you will not use this form.
Medicaid/Medicare ONLY Provider Demographics Form
This form should only be used for providers who are setting up biling services for the first time.
Billing Services Set-up Demographics
CAQH Authorization & Release of Information
New Business Set-up Demographics

Have questions? email us!

Let’s Get Started!

Provider Credentialing Demographics (Licensed, APRN, MD, BCBA, & RBT)

Business & Business Owners Demographics

Background Screening Clearinghouse

Medicare & Medicaid Enrollment

Billing Services Set-up

CAQH Authorization Form

New Business Practice Full Set-up