Application Process

Provider Type

  • Physicians 
  • Participating Physician Groups (PPG) 
    (does not apply to HSP)
  • Hospitals
  • Ancillary

Practitioners or organizational providers subject to credentialing or recredentialing and contracting directly with the plan must submit a completed plan-approved application. By submitting a completed application, the practitioner or provider:

  • Affirms the completeness and truthfulness of representations made in the application, including lack of present illegal drug use.
  • Indicates a willingness to provide additional information required for the credentialing process.
  • Authorizes the plan to obtain information regarding the applicant's qualifications, competence or other information relevant to the credentialing review.
  • Releases the plan and its independent contractors, agents and employees from any liability connected with the credentialing review.