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P.O. Bo• Z1Z87 <br />Seattle, WA 88111-3287 <br />Aprll 25, 2018 <br />KITTITAS COUNTY HEAL TH DEPT <br />607 N NANUM ST <br />STE 102 <br />ELLENSBURG, WA 98926-2886 <br />Dear KITTITAS COUNTY HEALTH DEPT: <br />Thank you for your Interest in becoming a partlclpatfng provider with Asuris Northwest Health (Asuris). <br />Strong provider networ1<s are essential for the delivery of quellly health ca.re to our members. and we <br />appreciale your wHlingness to join our networks. <br />Enclosed are the necessary documents required to join our provider network(s). Please review and sign <br />~ch agreement using the following stepa: <br />1. Carefully review all documents <br />2. If you agree with the tenns of the agreement, click "Continuen In the green "Accept Terms" box <br />3. Follow'the Instructions to electronlcelly sign your agreement <br />4. A confirmation message wlll display once the terms of the agreement have been accepted <br />5. A final copy of the agreement wlU be elecfi'onlcally returned to you, along with an eSlgnatura <br />receipt document containing s gnature information <br />YOll'll ~elve an email from us that will confirm the network(•) you are participating on and your <br />effective date ·of pa~lcjpallon. <br />Important notet: <br />• Claims submitted before your effective date of participation will be processed as out-of- <br />network. <br />• You must agree to the tenns and electronically sign your provider agreement(s) to complete the <br />contracting proce&&. <br />• Delays In algnlng your agreement(s) wlll impact your network participation date and may require <br />that you complete the credentialing process again. <br />Vleit our provider website at asurjs.con, to view the tools and resource(; evallable to aaslst you fn ,lhe <br />contracting process. If you have any question&, please contact our Provider Relations team. Contact <br />lnformaUon is avallable In l),e Contact us section of our website . <br />Sincerely, <br />John S. Partin <br />Vice President <br />Network Management <br />Enclosures <br />Our provldet welffltte, QUfl•.com, ol!Gro a>ttflnlll'19 lnlorme1lon ond roao1,1rca1 to aupport yoi.,, <br />You can find lnfonnatton abO<JI mornblll confo, pi1t--1uthorlD~ci!I rttquirome~l• end muc;!l moro,•