Our new provider portal is officially LIVE! Register now for the iCircle provider portal by clicking on this link!

PROVIDER INFORMATION

We have collected helpful forms, documents and reminders for our providers.

Forms & Applications

NEW – Provider Portal

Open Case List Distribution Opt In Form

Join Our Network: Enrollment Application – Provider Group

Join Our Network: Enrollment Application – Provider Individual

Re-Credentialing Application

Provider Demographic Change Form

EFT Form

ERA Enrollment Instructions

Disclosure of Ownership & Control Interest Statement

Credentialing Application for Transportation

Authorization Revision Request Form

iCircle Services MLTC Clearinghouse Information

Service Authorization Format Changes Letter

iCircle Common Contacts

Provider Roster Template for Enrolling Individuals in a Group Practice

Authorization Information Change Form

Tips & More

DRA Notice

CMS-1500 Tip Sheet

Got A Question?
PROVIDER FAQS