For a faster turnaround, complete the application online. The individual application link will take you to our myPortal, our member portal. To apply, please create an account under "New User Registration — Individual" or "New User Registration — Group Administrator."
If you perform any of these procedures, please submit the appropriate questionnaires with your application.
- Infusion Therapy
- Nurse Midwife
- Pain Management
HIPAA-HITECH Business Associate Agreement
An agreement required by federal law concerning policies and procedures to assure the confidentiality of patient health information.