ONLINE PROVIDER APPLICATION
Please fill out the form below.
Fields marked with an asterisk (*) are required.
Rather Apply on the Phone?
Call 1-888-719-9990 or
Simple 3-Step Process
CREDENTIALING
- Submit your application
- Provide a copy of your actual fees
IMPLEMENTATION
- Review your fees and create your discounts
- Learn how to have the CHUSA conversation
GO LIVE
- Enroll patients
- Protect and grow your practice