We appreciate your interest in joining our informational sessions. We are currently working on scheduling larger forums and will soon provide you with options to select your preferred date and time. Please bookmark this link and check periodically for updates and to make your selection. If you have any questions, feel free to email us at abhnetwork@aetna.com.

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* 1. Practice Name:

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* 2. Practice Address:

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* 3. Provider Name:

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* 4. TIN:

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* 5. NPI:

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* 6. Attendee's First & Last Name (i.e., Provider, Office Manager, Front Office Staff):

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* 7. Attendee's Job Title (i.e., Provider, Office Manager, Front Office Staff):

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* 8. Office/Contact Phone Number:

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* 9. Email Address (Please review your email address for accuracy as this may delay your training):

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* 10. Please select the date and time you're reserving:

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* 11. Medicaid ID:

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* 12. If no Medicaid ID, are you applying?

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