One-Time Payment Form
PDF
Automatic Payment Form
PDF
Defines the terms of service between your practice and BillMed Management.
Medical Director (Owner) must sign and authorize additional persons with access to billing and financial data.
Business Associate Agreement (BAA)
PDF
HIPAA-compliant agreement required for handling PHI. Please complete and sign.
W-9 Form
PDF
Required for tax and payment purposes.
After completing the W-9, please email the signed PDF to office@billmedny.com.
Practice Information
PDF
Key details about your practice and owner. Complete all applicable fields.
Practice Information with Credentialing
PDF
Includes provider enrollment details for insurance networks.
New Ownership Form
PDF
Use to update ownership or management details for an existing practice.