New Intake Form

Enclosed for your review and immediate use is the NEW ATA-FL Patient Intake Form. Please replace the current form that you are using with this NEW form effective immediately. The form is updated to provide you with the ability to indicate the following:

If you have any questions regarding this use of the new form please contact your Provider Relations Representative or ATA-FL at 888-550-8800.

HIGHLIGHTS

Referring Provider Name and Referring Provider NPI

Place of Service

ICD-9 vs. ICD-10 (NOTE: After 10/1/2015 all forms must include ICD-10 per CMS regs)

Plan of Care-You must complete this section when submitting the form

Test Score Used and Test Results

FWA

All TNFL providers are required to report concerns about actual, potential or perceived misconduct to the TNFL Corporate Compliance Department at:

1 (866) 321-5550

Forms

For your convenience, our most commonly used physician and provider forms are available.

Portals

Our electronic tools make it easier and faster to check claim status, member eligibility, and more.

TNFL's newsletter allows us to broadcast general provider communications by email.

New Intake Form

HIGHLIGHTS

FWA

Forms

Portals

Newsletter