AHO Network - Belk Store Services, Inc.

Belk Store Services, Inc.
Provider Information

PROVIDERS	BELK STORE EMPLOYEES
Greeting	Nominate a Provider
Provider Intent to Participate	Discount Program Description

Re: Belk Store Services Inc.

Dear Provider:

Alternative Healthcare Options (AHO) is pleased to announce that it has been chosen by Belk Store Services, Inc. as the complementary and alternative medicine (CAM) PPO network to offer a discount program to its employees, effective January 01, 2002.

Therefore, Alternative Healthcare Options is pleased to invite you to apply for participation in its CAM PPO network. Please complete the following initial application and contract, and return it to Alternative Healthcare Options by November 01. Refer to the Provider Application checklist enclosed to assist you in this process and to ensure that your application is complete. After we receive your application, we will begin the credentialing process.

Alternative Healthcare Options is a unique complementary and alternative medicine (CAM) preferred provider organization (PPO). Alternative Healthcare Options’ mission is to integrate natural choices in health care through complementary and alternative medicine. We encompass a complete array of complementary and alternative services including, Licensed Acupuncturists, Chiropractors, Massage Therapists, Naturopathic Physicians, Medical Nutritionists, a Natural Pharmacy, and other wellness services (yoga, tai chi, weight management, and stress management).

AHO is the first organization in the region that provides benefits of CAM services and brings the marketing and contracting synergy demanded by the public and employer community.

Please feel free to contact me at (877) 203-3440, ext 14, with any questions or concerns.

Sincerely,

Richard G Dunn
President/CEO

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DISCOUNT PROGRAM DESCRIPTION

Complementary and Alternative Medicine Discount Program.

Complementary and alternative therapies are built on treating the cause and not just the symptom of a condition. This integrative approach is based on a partnership of patient and provider with which conventional and alternative therapies are used to enhance the body’s innate healing potential and that whenever possible, simple, safe and cost-effective treatments should be implemented before invasive and more expensive methods.

Belk Associates will have access to Providers at a discount of 20% - 30% off the normal billed charges.

Our Licensed Acupuncturists are certified by the National Commission for the Certification of Acupuncturist and Oriental Medicine. NCCAOM certification requires 1,800 hours of instruction, 1,000 hours of internship, passage of a comprehensive set of written and practical examination, and commitment to the professional code of ethics.

Our Naturopathic Physicians have attended an accredited naturopathic school for a 4-year graduate-level naturopathic medical program, following three years of standard pre-medical education, with training in basic and clinical medical sciences equivalent to that of an M.D.

Our Massage Therapists have attended an approved school and have successfully completed a minimum of 500 classroom hours of supervised instruction, passed an examination and are in good standing with the National Certification Board for Therapeutic Massage and Bodywork.

How does it work?

Select a provider from your AHO directory or visit the online directory for the most up to date information.
Call provider’s office for appointment.
Identify yourself as a member of AHO and an employee of Belk Stores.
If you are directed to a different provider, contact AHO to confirm the provider is an AHO PPO Provider, as the provider may be new to the group practice and may not be a participating provider.

AHO is in the final stages of developing a network for Belk Stores and a complete network will be available on the web site, by December 01, 2001. If you have an alternative provider you wish to nominate for inclusion in the network, please contact AHO for a Provider Nomination form. AHO maintains a strict certification process to verify that all practitioners’ credentials are in accordance with National Commission on Quality Assurance guidelines.

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NOMINATE A PROVIDER

AHO is in the final stages of developing a network for Belk Stores and a complete network will be available on the web site, by December 01, 2001. If you have an alternative provider you wish to nominate, please submit the information in the form below and we will extend that provider an invitation.

Your Employer:

Name:

Email:

Provider Name:

Provider Address:

City/State/Zip:

Provider Telephone:

Specialty:

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NOTICE OF INTENT TO PARTICIPATE

Please take a minute to fill out our online form. When you click submit, we will get an email of this short application. After you finish the notice of intent, please click on PROVIDER APPLICATIONS to obtain a detailed application online. If you have any questions please contact Richard Dunn at 1-877-203-3440 ext 14.

ALTERNATIVE HEALTHCARE OPTIONS
INITIAL PARTICIPATING PROVIDER AGREEMENT
CERTIFICATE OF PARTICIPATION

I, (“PROVIDER”) a Participating Provider in good standing hereby tender this Certificate of Participation in Alternative Healthcare Options (“AHO”) upon the terms and conditions set forth in this Initial AHO Participating Provider Agreement. (We will be requesting your fee schedule and insurance information at a later date)

The undersigned represents and warrants that:

I am licensed/registered to practice in and my license/ registration is in good standing. I am engaged in active practice of Complementary and Alternative Medicine with adequate practice facilities and equipment.

I agree to provide a 20% discount off my usual and customary charges or to be responsible for collecting a co-pay and then bill AHO the remaining balance of my usual and customary charges and accept third party reimbursements for covered serves, when applicable, for members of AHO.

I attest that I maintain an appropriate level of Professional Liability Insurance and that no claims have been made against me.

I agree to all the Terms and Conditions of this Initial AHO Participating Provider Agreement. I also understand that a full and complete application and agreement will follow and supersede this Agreement.

The undersigned Participating Provider herby agrees to the Terms and Conditions of this Initial Agreement on this day of , year

Provider's Name:	Your name here is your online signature.
Email:
Tax Id :
Clinic / Office Name:
Address:
City, State, Zip:
County:
Business Phone:
Business Fax:

After you submit your intent notice, you will be taken to an area
where you can obtain the full application form.

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Your Employer:
Name:
Email:
Provider Name:
Provider Address:
City/State/Zip:
Provider Telephone:
Specialty: