Provider Application Request
Complete the form below to begin your application to join the Alliance network of providers. A Provider Relations Representative will be in touch promptly to discuss your next steps in the application process.
Please note that we can’t guarantee that providers applying to contract with the Alliance will become contracted providers. Providers are subject to reviews based on Alliance qualification standards. If you have questions about the application request form, please contact our Provider Relations team at 800-700-3874, ext. 5504.
Contact Provider Services
General | 831-430-5504 |
Cov Kev Thov Billing questions, claims status, general claims information |
831-430-5503 |
Authorizations General authorization information or questions |
831-430-5506 |
Authorization Status Checking the status of submitted authorizations |
831-430-5511 |
Lub Tsev Muag Tshuaj Authorizations, general pharmacy information or questions |
831-430-5507 |