Join THC’s Network – It’s as Easy as 1-2-3

  1. Complete and sign the Provider Agreement.
  2. Submit one of the following:
    • Completed and signed Provider Application or
    • Updated CAQH Summary and signed Affirmation page (in lieu of our application).
  3. 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.  

Need assistance? Call (877) 297-8864 or email

THC Provider Enrollment Materials

THG Affirmation and Release Form NY

Download

THG Participating Provider Agreement

Download

THG Physicians Application NY

Download