ONLINE PROVIDER APPLICATION

Please fill out the form below.

Fields marked with an asterisk (*) are required.

Rather Apply on the Phone?

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