Join Our Network

Please read our Standards of Participation before filling out this form. Access our Provider Manual to learn more about THP during the contracting process.

Organizations that are not currently contracted with The Health Plan (THP) may request to join the network by completing the form below.

If your organization is already contracted with THP and you need to add a provider, please complete the Credentialing Request Form located on THP’s secure provider portal.

Group Information
Provider Information

If multiple providers practice under the group, you may skip this section and continue to the Contact Information portion of the form, as our team will request a full practice roster during the contracting process.

Primary Practice Address
Submitter Contact Information
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Required
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