Enrollment Kit - landmark (chiro & ACUPUNCTURE)
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"Current As Of" signifies the latest date on which a Word & Brown
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revised version accessible.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines Landmark Healthplan’s case submission requirements.
Sold Group Paperwork:
- Group Application Form - Eff. 1/1/2020
- Please be sure to check "Standard" or "Expanded" or both and enter rates for all 4 tiers, even if you do not have enrollment in one or more of the tiers.
- Landmark Enrollment Census (preferred) or Individual Enrollment Forms - Effective 1/1/2021
- Current copy of the group's detail medical billing to verify eligibility or copy of medical ID card for waivers
- Copy of the binder check. Original should be made out to "Landmark Healthplan of California, Inc."
- Copy of broker license (first case only)
For other useful or older documents, please refer to the Forms database.