Individual Provider Credentialing

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All individual providers seeking participation in our provider network must go through the credentialing process.

The following are the minimum requirements for individual provider participation qualification:

  • Application and attestation, Magnacare/MagnaCare Casualty/Create® or current, attested CAQH profile
  • Signed contract
  • Current and valid license to practice
  • Appropriate training, including board certification
  • Current malpractice insurance with minimum limits of $1,000,000/3,000,000
  • DEA (if prescribing controlled substances)
  • Acceptable malpractice and sanction history

To request an application for individual participation, email [email protected].

All application submissions must include a W-9 form.

Per New York State law, notification of the credentialing decision by the Provider Credentialing Committee will be mailed within 90 days of the receipt of a completed application. If the application is incomplete, notification will be sent to the credentialing contact email address provided on the CAQH profile or, in the absence of CAQH, the email provided on the application. For individual application status, email [email protected].