Documents

  • New Business Application Application to join the Amplifon provider network Download
  • Provider Handbook The handbook for understanding our provider program Download
  • Code of Ethics Our comprehensive code of ethics Download
General
  • Provider Portal Guide How to use our Provider Portal Download
  • Provider Portal Login Help How to reset your password, change your login, etc. Download
  • Explanation of Payments Guide How to print your Explanation of Payments Download
Miracle-Ear
  • Provider Portal Guide (M-E) How to use our Provider Portal for Miracle-Ear Download
  • Provider Portal Login Help (M-E) How to reset your password, change your login, etc. Download
  • Locating Amplifon Referrals (M-E) Where to find referral information in the Provider Portal Download
Ordering
  • Manufacturer Account Numbers Hearing aid manufacturer bill-to numbers Download
  • Miracle-Ear Ordering Ordering Miracle-Ear products on MyMemsi.com Download
Reimbursement
  • Processing Checks Entering electronic checks in the Provider Portal Download
  • Returns & Exchanges The quick guide to returns and exchanges Download
  • Office Staff Portal Access Form Office staff account approval form Download
  • Provider Update Form Updating information about your providers Download
  • Business Update Form Updating information about your clinic locations Download
  • Authorized Contact Form Share who is authorized to make changes to your account Download
  • W-9 Form Request for taxpayer identification number and certification Download
  • Disclosure of Ownership and Controlling Interest Form To be completed by the owner(s) of record of your clinic Download
  • Disclosure of Ownership and Controlling Interest Form_Instruction Guide Guide for completing the disclosure of ownership form Download
  • Provider Rights Review your rights as an AHHC participating provider and business Download
  • Workers' Comp Portal Guide How to use the workers' compensation dashboard Download
  • Workers' Comp Portal Guide (M-E) How to use the workers' compensation dashboard for Miracle-Ear Download
  • Workers' Comp Referral Form Workers' compensation referral request form Download
  • Policies, Procedures, and Code of Conduct How to prevent, detect, and correct noncompliance and fraud, waste and abuse Download
  • Effective Lines of Communication Compliance communication policies and procedures Download
  • Disciplinary Standards Disciplinary standards for compliance program violations Download
  • Monitoring, Auditing and Identification of Compliance Risks Monitoring, auditing, and identifying potential risk for noncompliance Download
  • Response to Compliance Issues Procedures and system for promptly responding to compliance issues Download
  • Use of Protected Health Information How to appropriately use PHI within the course of your work Download
  • 2019 Amplifon Compliance Attestation Attestation to comply with the CMS requirements Download
  • FDR Offshore Subcontractor Attestation Attestation of offshore subcontractor protection of PHI Download