If you’re an ancillary provider, follow the steps below to be considered for acceptance in our networks.
Step 1 – Request your ancillary provider record ID
Complete the Ancillary Provider Record ID Request Form and email it to our Network Operations Facility team. You will receive a confirmation email when your provider record ID set up is complete.
Step 2 – Complete the ancillary credentialing application process
Once you have your provider record ID number, fill out the Ancillary Credentialing Application Form to initiate the credentialing and contracting process.
Instructions on where to submit your completed application are listed on the form according to provider type.
Check the Ancillary Credentialing Checklist for required supporting documentation to include.
You’ll be assigned a case number once we receive all required information.
Step 3 – Get contracted
Once credentialing has been approved, we’ll email you a contract via DocuSign for participation in the ancillary networks for which you qualify. Follow the provided instructions to complete and return the contract.
Step 4 – Wait for final notification of acceptance
After we receive your signed contract and it is approved, you’ll receive a welcome letter with your network effective date.