Physician compensation forms

1971

Alternative Payment Arrangement Application
This application form is for physicians who are compensated through fee-for-service (FFS) and seeking to move to compensation through an Alternative Payment Arrangement (APA) to deliver the same clinical services.

• Alternative Payment Arrangement Application (PDF, 628KB)
• More information

Assign reporting of services to an APP service contract payee number.

• Assignment of Payment - Alternative Payments Program (PDF, 115KB)
• More information

Application for Additional Payment Number

• Application for Additiona l Payment Number (PDF, 708KB)
• Y-Status Payee
• More information

Contract Payee Reservation Request

• Contract Payee Reservation Request

2804

Approved physicians must complete this form in order to be paid for travel expenses under the NITAOP.

• Application for Expenses (Northern & Isolation Travel Assistance Outreach Program (NITAOP)) (PDF, 524KB)
• More information

2854

Physicians wanting to apply for Advanced Skills and Training funding through the Rural Education Action Plan (REAP) must complete this form.

• REAP Skills Application (PDF, 203KB)
• More information

2856

Health authorities complete this form to apply for recruitment incentive payments for physicians recruited to eligible rural communities.

• Recruitment Incentive Benefit (PDF, 530KB)
• More information

2857

Health authorities complete this form to apply for funding to assist with physician recruitment to eligible rural communities.

• Recruitment Contingency Fund Application and Guidelines (PDF, 645KB)
• More information