Service Centers // Provider Center 2021

Add Provider to My Existing Group

Complete the form below to add a provider to your Group that is currently contracted with HealthSmart Preferred Network.

PLEASE NOTE: If provider practices exclusively within the inpatient setting (Pathology, ER, Anesthesiology, Radiology, Nurse Practitioner, Physician Assistant, etc), please complete the ADD Provider to my existing Hospital Group form.

Group Information

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Completed By

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Example: (555) 555-5555 or 555-555-5555

Provider Information

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Please go to https://proview.caqh.org/ to ensure your information matches the information you have included in this application.
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