Provider Resource Page

Provider Portal Resources

• Provider Portal Manual

• Order Quick Guide   

• Referral Quick Guide

Start Hearing Credentialing

• Owner Application Packet

• Professional Application (add a provider or credentialed location)

• Owner Application Packet - Fillable PDF

• Owner Application Instructions

• Electronic Credentialing Portal

Forms

• AudioNet Claim Worksheet

• Coal Claim Worksheet

• Custom Repair and Remake Form

• Justification Form

• Loss and Damage Replacement Form

• Medical Clearance Form

• Return Exchange Form

• Standard Hearing Aid and Wireless- Accessory Repair Form

• Workers Comp, Coal and AudioNet Delivery Form

Order Forms

• Omega AI, Edge AI & Genesis AI Custom Order Form

• RIC/Custom Cased Receiver Order Form

• Earmold Order Form

• Evolv AI Custom Order Form

• Signature Series Order Form

• BTE Order Form

• Audibel Aris AI and Intrigue AI Order Form

• Audibel RIC/Custom Cased Received Order Form

• Aubibel RIC/Absolute Power Custom Receiver Order Form

• Audibel Signature Series Order Form

• Audibel Arc AI Custom Order Form