EvidentRCM

Client Intake & Onboarding

Tell us about your practice so we can begin implementation. Most fields take just a minute — providers and facilities can be added as needed.

Don’t fill this out:

Practice information

Practice name *

Tax ID (TIN) *

Group NPI

Taxonomy

Main phone

Physical address

Billing / payment address

Same as physical address

Fax number

Rendering providers

Add each individual provider whose claims we’ll be handling.

Facilities & service locations

Offices, ASCs, or hospitals where services are performed.

Authorized point of contact

Contact name *

Role / title

Email *

Phone

Practice management / billing system Don’t share passwords here — we’ll set up secure system access with you directly after onboarding.

Use Evident Practice Management System

Services requested

Select all that apply.

Anything else we should know?

Evident RCM operates as a HIPAA Business Associate. We execute a BAA with every client before accessing protected health information. Questions? hipaa@evidentrcm.com

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Intake received

Thank you — your practice details are with our team. We’ll reach out within one business day to schedule your onboarding call and Revenue Architecture Review.