Become an ATR Provider
How to become an ATR provider
If you are interested in becoming an ATR provider, please contact Casey Tiewenwerth at ctiefenwerth@ahpnet.com to discuss the particular option you would like to offer ATR participants and how that would fit into the ATR model of services. She will explain how the ATR program works, how providers are paid for delivering the services, what the responsibilities are for the provider, and how to fill out the application to become an authorized provider by the Commonwealth of MA. She will give you individualized attention throughout the whole process to make to make it as easy as possible for you.
The ATR program prides itself on superb customer service, and this starts at the very beginning—at the time of application.
Complete, sign, and return the Provider Checklist, which lists all of the required documentation and steps to be taken to become part of the ATR Provider Network
Forms Required When Applying
- ATR Provider Application
- W-9
- Provider Bank Information
- Participating Provider Agreement
- Confidentiality Pledge
- DPH Confidentiality Agreement
- Provider Staff Authorization Form
- Standard Terms & Conditions
- Provider Manual
For questions about the application process or any of the required documentation, please contact:
Casey Tiefenwerth – Career Building Initiative Program Manager
Email: ctiefenwerth@ahpnet.com