State Credentialing Forms

Providers in the states listed below may use their state’s form in place of the Claritev form for initial credentialing when applying to join our networks or for recredentialing purposes. The forms are posted below for your convenience. (Note that to apply to join our networks, these forms must be accompanied by a completed and signed Claritev provider contract.)

For questions about our credentialing process or joining our networks, call our Service Operations Department at 1-800-950-7040.