Document Library

New Member Applications


Doctors

Physician Credentialing Application Packet

Physician Assistant Application

PA Credentialing Application Packet

Nurse Practitioner Application

NP Credentialing Application Packet

Other Mid-Levels

AHP (not NP or PA) Credentialing Application Packet

TIOPA Provider Relations Packet- Includes Plan Participation Checklist and Forms (Part of Application)

2020 Provider Relations Packet Form

TIOPA Plan Participation Checklist

Plan Participation Checklist- w Instructions

EXTRA SERVICES 

Extra Services Interest Form

https://docs.google.com/forms/d/e/1FAIpQLSfRBDekeensINbzuhnWst2d5li4IaAsZQHChMBwV9a5awZZ5A/viewform

Extra Services Information (needed from Provider to get BCBS, Medicare, or Medicaid numbers)

http://bit.ly/ExtraServiceFormTIOPA