Providers > Credentialing

Getting started.

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
(215) 746-7906
Fax: (215) 573-6465

The next step, contract and credentialing.

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.

Attachment details and forms

Please select one of the links below for more information related to the credentialing process

 

Level of Care (PDF)


Provider Guide


Delegated Group Agreement (PDF)


Facility Agreement (PDF)


Individual Agreement (PDF)