Getting Started

• Welcome to MPMS!   You will need to complete the following information in order to get started: the Provider Enrollment Form, Business Associates Addendum and the Billing Services Agreement.  In addition to those three forms, we will need the following documentation from your office:

   

  • Copy of all degrees
  • Copy signed of your current professional license
  • Current Malpractice Facer Sheet
  • Copy of your current Board Certification, if applicable
  • Copy of your Curriculum Vitae (CV), with all milestones having a start and end date in mm/yyyy format
  • Three professional references
  • Copy of your Social Security Card
  • Copies of all degrees
  • Act 33 is the Pennsylvania Child Abuse History Certification
  • Act 34 is the Pennsylvania State Police criminal record check
  • FBI clearances are the Federal Bureau of Investigation clearances
  • Docketing Forms
  • IRS CP 575 form
  • Blank voided check

   

  Please download and complete these documents.  Once completed you may submit your forms in whichever method is most convenient to you:

  • Fax them to 724-387-2456
  • Email them to melissa@mpms.info

  MPMS Forms:

  • Billing Services Agreement (for full-service billing clients)
  • Credentialing Services Agreement (for credentialing only clients)
  • Credit Card Authorization
  • Provider Enrollment Form
  • Business Associates Addendum
  • Compliance Manual

  For your convenience, MPMS accepts VISA and MASTERCARD.  If you are paying by credit card you will receive an invoice on the first of each month and your credit card will be billed each month.  Credentialing only clients MUST submit a credit card authorization form and will be billed according the the Credentialing Services Agreement.  Please print and complete the Credit Card Authorization form and fax it to Melissa at 724-387-2456 to start the credit card billing process. You may also pay on-line at our website or submit payment via check.