MO Coventry Health Care Provider Participation Request Form 2012-2025 free printable template

PROVIDER PARTICIPATION REQUEST FORM For Individual Practitioners and Facility/Ancillary providers CPD: Practitioner CASH ID: Coventry Use Only Fax: 866-874-6403 Phone: 314-506-1815 550 Maryville Center

How to fill out provider participation request form

How to fill out MO Coventry Health Care Provider Participation Request

1. Obtain the MO Coventry Health Care Provider Participation Request form from the official Coventry website or your local Coventry office.
2. Fill in your personal information, including your name, address, and contact details.
3. Provide your National Provider Identifier (NPI) number and any relevant practice information.
4. Complete the sections related to your specialty and practice type.
5. Review the provider qualifications and ensure you meet the criteria outlined on the form.
6. Attach any necessary documents, such as licenses, certifications, or proof of malpractice insurance.
7. Sign and date the application to confirm the information is accurate and complete.
8. Submit the completed form and accompanying documents to the appropriate Coventry office, either by mail or electronically, as specified.

Who needs MO Coventry Health Care Provider Participation Request?

1. Healthcare providers who wish to participate in the MO Coventry Health Care network.
2. New practices seeking to join Coventry for insurance participation.
3. Current Coventry providers who need to update their participation information or credentials.

People Also Ask about

Is Coventry still an insurance company?

Coventry Health and Life Insurance Company provides insurance plans to Missouri residents.

Is Coventry a PPO?

Like many insurance companies, Coventry Health and Life Insurance Company offers the following types of health plans: PPO and EPO.

What insurance is Coventry?

Coventry Health Care Inc., often referred to as Coventry, is a national health insurance company. The diversified company is dedicated to providing affordable and high-quality health insurance solutions to its customers.

What is the fax number for Coventry claims?

Coventry - 1-800-288-3343 or Fax 1-866-602-1249.

Is Coventry still part of Aetna?

You can use the same websites and tools you've always used to submit claims, precertify and access referral requests. Remember, Aetna and Coventry are the same company, so you and your patients may see either name or logo on the communications we send to you. We're always working to improve your experience.

Is First health and Coventry the same?

In the merger, First Health will merge with and into Coventry Merger Sub Inc., which is a Delaware corporation and wholly owned subsidiary of Coventry. Merger Sub will continue after the merger as the surviving entity and a wholly owned subsidiary of Coventry.

Who owns Coventry First?

Founded in 1999, the company is controlled by CEO Alan Buerger and family.

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What is MO Coventry Health Care Provider Participation Request?

The MO Coventry Health Care Provider Participation Request is a document that healthcare providers must submit to participate in the Coventry Health Care network in Missouri.

Who is required to file MO Coventry Health Care Provider Participation Request?

Healthcare providers, including physicians, specialists, and facilities that wish to join the Coventry Health Care network, are required to file this request.

How to fill out MO Coventry Health Care Provider Participation Request?

To fill out the MO Coventry Health Care Provider Participation Request, providers should complete the form with their professional and business information, including credentials, services provided, and signature, and then submit it according to the guidelines provided.

What is the purpose of MO Coventry Health Care Provider Participation Request?

The purpose of the MO Coventry Health Care Provider Participation Request is to assess and credential healthcare providers for participation in the Coventry Health Care network to ensure quality and compliance with network standards.

What information must be reported on MO Coventry Health Care Provider Participation Request?

The information that must be reported includes provider's name, contact information, professional qualifications, practice details, specialties, and other relevant documentation as required by Coventry Health Care.