Clinical Integration Physician Participation Agreement Form

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Welcome


PREAMBLE

The goal of Kettering Health Physician Partners, LLC (CIN) is to lay the foundation for participating physicians and Kettering Health to develop a system of care aligned across the entire patient care continuum which will result in seamless high quality and high value care - safe, timely, effective, efficient and patient focused.

CIN will partner with Kettering Health physicians, hospitals and ambulatory care sites in order to create a single voice for interaction with our patient, business partner and payer communities on behalf of CIN. Through this effort, CIN will be recognized nationally for the transformation of the delivery of health care in the communities we serve.


BEFORE YOU START

Here is a list of things to have ready to make going through this form easier and quicker.

  • If Physician is a Group Member, have the names of all individual participating physicians and other providers of Group Member ready to add into Attachment A of form.

  • If Physician is a Group Member, have the primary office street address ready.

  • Have your Contract Categories already decided. Here is a list of current options .

  • Be prepared to answer questions if employed by a Competing Organization or have ownership interest in an Ancillary Facility.

  • Be prepared to attach appropriate documentation or explaination if needed about your history.

  • Be prepared to share your Malpractice Insurance and expiration date as well as Spec/AG Coverage.

  • Be prepared to agree to release your credentialing information from a Medical Staff Office: Need CAQH ID, Group NPI and Tax ID.

Questions before you start?

Email us at ketteringhealthphysicianpartners@ketteringhealth.org.