Join Our Provider Network

We provide high-quality, cost-effective, outcomes-oriented care to our members. You are our ally in achieving that goal, and we are grateful for your participation. In support of our commitment to high-quality health care for our members, we invite you to apply to become a provider in our network.

To apply for our network, please follow the outlined process below. Complete the Prospective Provider Form completely and submit along with the following supporting documents:

  • Current Signed W9
  • Sample claim form - NO PHI
  • Groups: Submit a current roster of providers and their servicing locations
  • Facilities: Submit a current roster of locations

Once all documents are ready, please submit an email using the provider’s name on the W9 as the subject line. Then please submit this request for review to our Network Team box at: Once we have received a complete application package, we review these applications within 45-60 days. We will notify the applying provider with our decision via the email used to submit the application.

Providers must meet the following requirements to be eligible criteria to provide care to our members:

  • Have privileges at a participating hospital as applicable to your specialty type
  • Hold a current and valid state medical license to practice, free of sanctions, board orders, probation, restrictions and/or limitations, verified by the state licensing agency and disclose any history of loss of license or felony convictions
  • Be board certified or have fulfilled the requirement needed to meet the time limits for certification from the specialty board of the provider’s area of practice
  • Facility or ancillary provider, must be CMS certified, be accredited JACHO or other nationally recognized and accepted regulatory agency.
  • Nationally recognized quality measures such as HEDIS, STARs and Leapfrog data may be used to evaluate provider’s application.
  • Eligible to treat Medicare and/or Medicaid patients and not be under investigation or suspension from participation in a federal or state health care program
  • Ability to meet access and availability standards and network adequacy needs
  • Submit the credentialing application correctly and completely.
  • Be fully credentialed.
  • Sign, date and return all contract documents.

Last Updated: 02/16/2024