---
sourceDocument: Brazil Employee Service Management
sourceDocumentLink: https://www.servicenow.com/docs/r/employee-service-management

 Release :

    - brazil

ft:locale :

    - en-US

ft:publication_title :

    - Brazil Employee Service Management

ft:clusterId :

    - emplsm

bundleId :

    - emplsm

workflow :

    - Employee


---

# Payers Enrollment form

# Payers Enrollment form {#ariaid-title1}

Release version: Brazil  
Updated September 10, 2026  
![](https://www.servicenow.com/docs/portal-asset/ico-clock) 1 minute to read  
Access, review and validate the Payers Enrollment details of a healthcare professional in the Payer enrollment form.
{#hr-payer-en__table_l3d_s5j_jbc__entry__2}

| Field | Description |
|-|-|
| Healthcare professional profile | Profile associated to healthcare professional. |
| Payer name | Name of payer who makes payments to the healthcare provider. |
| Payer plan name | Name of payer plan. |
| Plan number | Unique plan number against which payments are made by healthcare provider. |
| Active | Option to indicate that the payer enrolment record is active. |
| Effective From | Date starting which payer enrolment is valid. |
| Effective Till | Date until which payer enrolment is valid. |
[Table 1. Payers Enrollment form]

{#hr-payer-en__table_l3d_s5j_jbc}
**Related reference**   

* [Installed with HR Service Delivery for Healthcare](https://www.servicenow.com/docs/w22iR_uWCp2qfMYvoiyvpw "Several types of components are installed with activation of the HR Service Delivery for Healthcare plugin, including tables and user roles.")
* [Healthcare professional profile form](https://www.servicenow.com/docs/lCTd6653mHQLFznlcGSqyw "Access and update confidential HR data for a healthcare professional. This includes name, personal contact information, email addresses, professional liability insurance details, and medical degree.")
* [Professional ID form](https://www.servicenow.com/docs/PumIEPUlQesuFvCzO1OgLw "Access, update, and validate the Professional ID details of a healthcare professional in the Professional ID form.")
* [Professional liability Insurances form](https://www.servicenow.com/docs/4FYWYX01uof2UmSUaEgoaQ "Access, update, and validate the Professional liability Insurance details of a healthcare professional in the Professional liability form.")
* [Professional reference form](https://www.servicenow.com/docs/N2G~vMxrwvhFfpTel5CMhQ "Access and validate the Professional reference details of a healthcare professional in the Professional reference form.")
* [Professional speciality form](https://www.servicenow.com/docs/usIsbkE4uLdNdyTFhSoxVg "Review and update the Professional speciality details of a healthcare professional in the Professional speciality form.")
* [Malpractice history form](https://www.servicenow.com/docs/jSirHfpIF79PNrDPiJs7Dg "Access, update, and validate the Malpractice history details of a healthcare professional in the Malpractice history form.")
* [Education and Training form](https://www.servicenow.com/docs/o5DozhlibaqkW7C2gEx5NQ "Access, update and validate the Education and training details of a healthcare professional in the Education and training form.")
* [Practice location form](https://www.servicenow.com/docs/EFh9ruHfRy0~b~~J9blZBA "Access, update, and validate the practice location details of a healthcare professional in the Practice location form.")
* [Employment history form](https://www.servicenow.com/docs/hq_4MK~4AizKwd8eOUrFoA "Access, update, and validate the Employment history details of a healthcare professional in the Employment history form.")
* [Languages Spoken form](https://www.servicenow.com/docs/iANMZm5evBrm4xNAqqThug "Access, update, and validate the language details of a healthcare professional in the Languages form.")
* [Hospital Affiliations form](https://www.servicenow.com/docs/AkH5g8_0QOdgIDb1sDeZzA "Access, review and validate the Hospital Affiliation details of a healthcare professional in the Hospital Affiliations form.")
* [Healthcare Employee Onboarding form](https://www.servicenow.com/docs/fdwmtlNZLLVSjoc4GNc1rg "A hiring agent or a manager places an onboarding request for a healthcare professional via the Healthcare Employee onboarding form in Employee Center.")