Skip to main content

Contracts and Forms

HealthChoice will only accept the current versions of the contract and application and provider forms. HealthChoice consolidated the provider contracts into three documents. Providers can choose one of three – Practitioner, Independent Health Organization and Facility. To determine which one is most appropriate for you, refer to Page 2 of the applicable contract and application.

Current network providers who wish to add a new TIN to their provider record must submit a new contract and application.

HealthChoice has also updated the additional office location and change forms. The new forms can be used by all network practitioners, independent health organizations and facilities.

Non-Network providers can update their billing address by filing a new claim.

For the fastest turnaround time and to maintain electronic documents, email your documents to HealthChoice accepts digital and e-signatures on all contracts, applications and forms.

Contracts and applications

Each contract below contains the appropriate application and a list of the required attachments. Complete the application by entering the required information in the open fields and sign electronically or digitally. Completing and signing electronically makes them easier to read, which results in fewer mistakes, questions and delays in processing your application. You can then email the contract, application and attachments to


NOTICE: Non-network providers
Do not use the network provider forms to add a location or change your practice information. Please call the claims administrator directly at 800-323-4314. TTY users call 711. The forms are for network providers only.

Last Modified on Mar 05, 2024
Back to Top