RESOURCES

Group Practice Application

Complete this form AFTER you have completed the the "Request a Quote" page and if this is the group practice's FIRST time joining CredMax PDM.

Provider Group Roster Template

Complete this roster to attach to a new provider group application or if you are requesting to add more than 5 new providers to an existing group.

Add/Update/Term Provider

Complete this form to add a new provider, update or terminate an existing provider from an existing group. If you joined us as an individual provider, you can use this form to make updates to your profile.

Add/Update/Term Practice Location

Complete this form to add a new practice location, update or terminate an existing location from an existing group.

Request Additional Payor Enrollments

Complete this form if you would like to become In-Network with an new payor. If you have executed a new contract or are in the process of a new contract with a new payor to begin the enrollment process.

CAQH Profile Management Request

Complete this form if you are a provider group or individual provider and would like your CAQH Profile to be assigned to one of our specialist for comprehensive management. You won't have to worry about re-attestations anymore.