- Complete and sign the Provider Agreement.
- Submit one of the following:
- Completed and signed Provider Application or
- Updated CAQH Summary and signed Affirmation page (in lieu of our application).
- Enclose copies of the applicable credentials:
- State License
- Malpractice Insurance FACE sheet
- DEA Certificate (if applicable)
Once we have a signed Agreement and have reviewed the credentialing documentation, we will send a confirmation.