Prior to sending the contract, please confirm that the Urgent Care Center (UCC) meets the guidelines listed below.
- Extended hours – UCC must be opened weekday evenings until at least 7:00pm. Weekend hours are preferred but not required.
- Defibrillator – If not physically adjacent to an Emergency Room, UCC must have a defibrillator in the office.
- Tax ID Number- UCC must have its own provider number and Tax ID number.
- UCC Summary – UCC must complete the Urgent Care Center Summary (Attachment C) and return it with their application.
- CMS -1500 form – All professional services are required to be billed on a current CMS – 1500 form. Institutional charges cannot be billed in conjunction with Urgent Care Center services.