Muscle & Nerve
Neuromuscular Foundation
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American Association of Neuromuscular & Electrodiagnostic Medicine
Improving the Lives of Patients with Neuromuscular Diseases
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About
Vision, Mission & Values
Board & Committees
Committee Opportunities
AANEM Staff
Work at AANEM
History
Founding Members
Contact Us
Education
Learning Center
Transcript
Podcasts
Self-Assessment Examinations
Using SAEs as Study Guides
SAEs for Training Programs
Education for Technologists
Ethics
CME/CEU
Meeting Your MOC
Suggested Reference List
Meetings
Annual Meeting
Plenary Sessions
Abstract Information and Submission
Session Proposal
Future Annual Meetings
Spring Virtual Conference
UltraEMG
Exhibits, Sponsorships & Advertising
Corporate Support
Membership
Join AANEM
Value of Membership
Eligibility Requirements
Membership Application
Membership Dues and Categories
Training Program Partnership
Initial Application
TPP Trainee Portal
TPP Director and Coordinator Portal
Member Portal
Renew Membership
Online Resource Library
AANEM Connect
Membership Directory
Achievement Awards
Get Involved
Residents & Fellows
Practice
COVID-19 Guidance
CARES Act Summary
Telemedicine
Guidelines
Guidelines Submission Form
Quality
Coding & Billing
Member-Only Coding Resources
Medicare
Quality Payment Program (QPP)
EDX Laboratory Accreditation
My Accreditation Dashboard
Process & Pricing
FAQs
Find an Accredited Lab
Featured Labs
Complaint Form
Practice FAQs
Practice Resources
Marketing Your Practice
Brochures
Member-Only Marketing Resources
Technology Reviews
Glossary of Terms
Advocacy
EMG State Laws
State Liaison Program
State Liaison Listing
Apply to Become a State Liaison
Position Statements
Fraud & Abuse
Payer Resources
Action Center
Contact Your Legislators
Advocacy Fund
Careers
Job Seekers
Employers
Fellowships
Manage a Fellowship
Open Houses
FAQs - Applicants
FAQs - Programs
Neuromuscular Medicine Fellowship Portal
Clinical Neurophysiology (EMG) Fellowship Portal
Other Fellowships
Patients
Muscle & Nerve Disorders
Types of Tests
FAQs Before EDX Testing
Find a Specialist
Muscle & Nerve
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With your help, the American Neuromuscular Foundation can fund research that will improve the lives of patients with neuromuscular diseases.
Apply to Become a State Liaison
First Name:
Last Name:
Phone Number:
E-mail:
State:
Name of Practice:
Practice Website:
Practice Address:
Specialty:
Physical Medicine and Rehabilitation
Neurology
Training program attended for residency:
Type of Practice:
Private Practice
Hospital-Based Group
University-Based Group
Government-Based Group
If you are in private practice, check all descriptors that apply:
1-2 Physicians
3-5 Physicians
6-15 Physicians
15+ Physicians
Single Specialty
Multispecialty
Which payors does your practice bill the most?:
Do you work with payors in any of the following capacities?:
I work as a medical director for an insurance company
I am a Carrier Advisory Committee (CAC) member
I work as a consultant for an insurance company
I develop coverage policies
I review new technology
I review claims for fraudulent billing
None of the above
Other work with payors
Please explain:
Discuss why you are interested in becoming a state liaison (1-2 paragraphs).:
Are you willing to meet with and work to develop relationships with key state and federal legislators and other elected officials as needed?:
Yes
No
Have you had any contact with any state and/or federal legislators? Or any other elected officials?:
Yes
No
If yes, please explain:
Do you have any existing relationships with any state and/or federal legislators? Or any other elected officials?:
Yes
No
If yes, please explain:
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