Carrier Relations
  Carriers may contact us at:  
  P.O. Box 40249, Austin, TX. 78704
Phone: 512.912.8202
Fax: 512.912.8206
Email: info@bmdmed.com 		 
 
  Visit our other websites:  
BMD Consulting Services
BMD Technology Consulting
BMD Training Resources
 

Healtcare Provider (Only) Enrollment

 
  If you are a healthcare provider and would like to be a part of our company, please fill out the enrollment form below. Once submitted your credentials will be reviewed by our credentialing staff and a determination will be made. Once a determination has been made our office will contact you regarding your enrollment.

If you are a representative for a carrier, please call us at 512.912.8200 for more information. Do not use the form below, it is for healthcare providers only.		  
  Healthcare Provider Enrollment Form:
Please fill out form as completely and as accuratly as possible. *Means Required Field. 		 
     
 
Name:*

Specialty:*
Sub Specialty:*
Are you licensed in Texas?*

Are you on the Texas ADL?*

Are you in Active Practice?*

Additional states you are licensed in: State: License:
     
     

Please list review any prior review experience (i.e. pre authorization, peer review etc.)*.

 
 

Are you currently performing reviews directly for any carrier or are you contracted with a review company?* 

Do you have access to email that you check regularly?* 

How many reviews would you be willing to take on a daily basis?*