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Professional Registration Form
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Join Our Provider Networks
We welcome healthcare professionals from a wide variety of specialties.
How to join:
• Fill out all the details in the Professional and Provider(Vendor) form online • Submit the form after reading the Terms of Agreement. • Use the temporary login created to view and update information through the process of registration. • Correspond with the plan using your temporary login. • Upload & Submit all the needed documents (Credentialing form, Contracts etc) using your temporary login. • Our Provider services agents will always be available to help complete the process.
What do you need to fill the Registration form:
• Demographic Information: First Name, Last Name • Specialty Information: Certification & Specialty Approval and Expiry Dates • Address Information: Address and Contact Details • Office Information: Patient Acceptance Criteria, Language and Working Hours.
• Provider(s) Name & Adress • Provider(s) TIN
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