For Facilities

To Request Network Participation

Health delivery organizations can become participating facilities in our networks. In this section, you can view the criteria and download the appropriate forms. If you submit an application only, you will be issued a provider number for claims filing purposes only and will be considered a non participating provider.  If you wish to participate in our networks you will need to contact Network Operations at 1.800.716.2299, option 3 to have the appropriate agreement(s) sent to you. 

To Request a Provider Number ONLY

Providers who meet the required criteria can view information on how to submit an application and download the appropriate forms to obtain a provider number only.


Providers are recredentialed every three years from the date of their last credentialing approval date. The recredentialing section shows what documents to submit in order to continue participation in our networks. Unless otherwise notified, providers should consider their recredentialing application approved for a three-year cycle.