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AllCare Health
Grants Pass, OR 97526
Fax: (541) 471-4128
Application For Network Participation
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Please contact us at (541) 471-4106 for more information.
Thank you for your interest in the AllCare Health Network!
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Organization Details
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Requested Health Plan (Select at least one)*:
Provider Details
Attach W-9
Attach Credentialing Packet
Disclaimer
"AllCare Health (“AllCare”) contracts with physicians/providers/facilities in Oregon to participate in one or more of the following health
plans administered by AllCare Health: AllCare CCO, and/or AllCare Advantage/AllCare Health Plan, Inc.
This Application for Network Participation (“Application”) allows individual physicians or licensed healthcare professionals to apply for
participation in one or more AllCare health plans as a member of the AllCare Health provider network.
AllCare will review your Application to ensure you meet initial participation criteria; please type legibly. AllCare will acknowledge receipt of
your completed Application within 7 business days. Incomplete forms will not be accepted.
Please note that submission of this Application does not guarantee you will be offered the opportunity to join the AllCare Health provider
network and participate in an AllCare health plan. Processing may take 90 to 120 days after receipt of your complete Application.
If your Application is accepted, we will include a credentialing application package with additional details. You will have the opportunity to
upload a current Oregon credentialing application if you have one completed. You may find the current application here
https://apps.state.or.us/Forms/Served/me9048.pdf.
If you are offered the opportunity to join an AllCare health plan, per ORS 743B.454 Claims submitted during credentialing period. (3)(a) A
health insurer shall pay all claims for medical services covered by the health insurer that are provided by a provider during the
credentialing period. At the rate paid to nonparticipating providers. “Credentialing period” means the period beginning on the date a
health insurer receives a complete application and ending on the date the health insurer approves or rejects the complete application or
90 days after the health insurer receives the complete application, whichever is earlier."
Thank you for submitting your application to join our network.
Your application will be reviewed by our team in the order in which it was received. Please allow up to 60 - 90 days to hear back from a representative from our team.
