] A signed network agreement for each network you wish to apply.Credentialing Application • January 24th, 2019
Our health plan partners no longer use paper remittances. This includes paper remittance advices and paper checks. You will receive payments and remittance advices electronically. If your group or practice is not currently enrolled in the Electronic Funds Transfer (EFT) program, be sure to complete both the Terms and Conditions for Electronic Payment and the Electronic Funds Transfer Enrollment Form and return them with your application.
DEPARTMENT OF CHILDREN AND FAMILIESCredentialing Application • January 12th, 2017
REQUIRED ATTACHMENTSCredentialing Application • October 23rd, 2014
] A signed network agreement for each network you wish to apply.Credentialing Application • March 22nd, 2016
Our health plan partners no longer use paper remittances. This includes paper remittance advices and paper checks. You will receive payments and remittance advices electronically. If your group or practice is not currently enrolled in the Electronic Funds Transfer (EFT) program, be sure to complete both the Terms and Conditions for Electronic Payment and the Electronic Funds Transfer Enrollment Form and return them with your application.
