Tools/Resources

If you credential and enroll Hospital Employed Providers at Hancock Regional Hospital, Hendricks Regional Health, Henry County Hospital, Riverview Hospital, Westview Medical Campus, and Witham Health Services you have access to these forms via the SHO Provider Portal.

• Payor Matrix for Contracting and Credentialing
• Credentialing-Enrollment Form
• Demographic Change Form

SHO Provider Portal

Information and forms provided in this section have been developed by Suburban Health Organization (SHO) as support for risk services (Advantage Membership). They apply solely to services provided by SHO.

Risk Services Resources

Used for Advantage Membership. These PDF forms require Adobe Reader to view.

• 1500 Claim Form
• Ancillary Directory
• Catholic Directive List
• Claim Payment for Physician Extenders
• EDI Provider Enrollment Form
• Prior Authorization List
• Prior Authorization Request
• Provider Claim Dispute Form
• Provider Claim Inquiry
• Provider Directory
• Provider Enrollment
• Provider Manual
• Quick Reference Card