ASG SERVICE PROVIDER NETWORK APPLICATION

WELCOME TO ADJUDICATION SERVICES GROUP

Thank you for your interest in joining the ASG Network of Service Providers.  The indsutry label is "vendor" but we believer you to be more than just that, we look at all our relationships as partnerships.  As such, we look forward to working with you to help bring the quality serices you provide to our clients while helping you to increase your referral volume and efficiencies through technology.  The process is as simple as 1 -2 - 3.
 
Step 1 - Non-Disclosure Agreement and Application.  We want to make sure that all parties are protected, we appreicate how hard you work in developing your processes and protocols.  The application and review process is confidential which is why the first step is the execution of a Mutual Non-Disclosure Agreement.
 
Step 2 - ASG Review and Assessement:  Once your application is received ASG will being the process of reviewing your information.  This process occurs in three (3) stages:
 
Stage 1: Review and Classification
ASG will review your application and contact you for any clarifications or additional questions that may arise during the process.  Once the application has been approved we move to the next stage.  If there are any areas which do not meet the required criteria you will be notified of the specific areas of deficiency and we will work with you to address the areas of improvement.  After 30 days if the items have not been addressed the application will be closed.
 
Stage 2: ASG Service Provider Agreement & Implementation Planning
Upon approval you will receive notification from ASG of your tentative activation along with the Service Provider Agreement and Business Associate Agreements for your review and execution.  Upon execution of the agreements we will discuss and formulate a plan for implemenation.
 
Stage 3:  Implementation
We will work with you in creating any required data feeds, establishing business rules and testing your connectivity with our ASGARD system in preparation for you to go live.
 
Step 3 - GO LIVE - you will be able to recieve referrals from any of ASG's clients based on your level of program participation.
 
So lets' get the ball rolling!  If you have any questions while completing the application you can email vendors@asgnational.com or call us at 631.358.5823.
 
We look forward to workign with you and establishign a long and mutually benefical working relationshiop.
 
Regards,
 
Damien Jonathan Caldwell
Chief Executive Officer
Adjudication Services Group
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