Skip to main content

Provider Forms

Effective Oct. 1, HealthChoice will only accept the current versions of the contract and application and provider forms. HealthChoice consolidated the provider contracts into three documents on Jan. 1. 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.

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.

Provider Forms

Changing your service information? Adding an additional location?

Contracts and Applications

Interested in becoming a provider?

Last Modified on Dec 30, 2022
Back to Top