Network Participation
Credentialing/Contract Requests
To request credentialing/contracting, complete the appropriate form (see options below).
To see if a provider is already credentialed/contracted, visit the Provider Directory.
To update provider information or add a tax ID, please use the Provider Information Change Form.
To add a line of business or request participation in another AZ Blue network, contact your Provider Relations Contact.
To terminate a contract or end an affiliation with a tax ID, use the Termination Form.
Medical Practitioners
Complete this form to request initial credentialing for providers not yet participating with AZ Blue (requires a CAQH profile and number). For updates (including adding a tax ID), use the Provider Information Change Form.
Facilities & Ancillary Providers
Complete this form to request credentialing and contracting. Also use this form to add a new location. For all other updates, use the Provider Information Change Form.
Dental Professionals
Complete this form to request credentialing and contracting. Requires a CAQH profile and number.
Medical Groups
New groups with five or more practitioners may qualify for an AZ Blue contract. To finalize, at least one must be credentialed with AZ Blue and the rest actively completing credentialing.
TriWest Healthcare Alliance Networks (for Veterans)
To get started with the TriWest Healthcare Alliance Network(s) you must be credentialed with AZ Blue and complete the TriWest Contract Request Form.
Chiropractors
American Specialty Health (ASH) handles credentialing and contracting for our chiropractic providers. For more information call 888-511-2743 or visit the ASH Provider Network page.Providers with Concierge Practices
Providers with concierge practices must meet specific requirements and sign a Concierge Practice Contract Addendum. For more information, reach out to your Provider Relations Contact.
Providers with Third-Party Consultant or Billing Company
Before AZ Blue provides information to or works with a consultant or billing company, the provider must complete and sign the AZ Blue attestation form.