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

PLEASE READ: Click to read New Claim Process Change

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

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