The first step in the credentialing process is to complete a Request Form (PDF).
Browse the links on the right to view sample agreements.
Send the completed request with your curriculum vitae via fax or mail to:
Network Development and Provider Relations
3535 Market Street, Suite 4080
Philadelphia, PA 19104
Fax: (215) 573-6465
Once the completed request form and CV are processed, qualified applicants will be contacted for rate information. When rate details are settled, you will receive an application package including contract and credentialing forms and instructions.
The application must be completed in its entirety. Incomplete applications will delay the credentialing process. Be aware that to expedite credentialing, you should submit the signed contract and complete credentialing application within 30 days of initial receipt.