Cardiovascular Screening and Follow-up Services (DHHS26081)

Welcome to the BeWise program application process. We appreciate your interest in joining our network as a BeWise screening and/or follow-up provider. Thank you for taking the time to complete this application and for your commitment to providing cardiovascular screening and/or follow-up services to program participants.

This application remains open to welcome qualified partners year around. Please complete all sections of the forms below to help us understand your practice and eligibility to provide program services.

Application Instructions
Submission Checklist
Conflict of Interest Disclosure Statement
Form W-9
Scope of Work A
Scope of Work B
Approved CPT Codes
Policy & Procedures Manual
Application A
Application B
Evaluation Score Sheet
Terms and Conditions