Complete the form below to add a provider to your Group that is currently contracted with HealthSmart Preferred Network.

PLEASE NOTE: If provider practices exclusively within the inpatient setting (Pathology, ER, Anesthesiology, Radiology, Nurse Practitioner, Physician Assistant, etc), please complete the ADD Provider to my existing Hospital Group form.

The entered values cannot be saved. Please see the fields below for details.
Group Information
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Requires 10 numerical characters.
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Requires 9 numerical characters.
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Completed By
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Please enter email value in format 'mymail@domain.com'.
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Invalid phone number.
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Example: (555) 555-5555 or 555-555-5555

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Provider Information
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Requires 9 numerical characters.
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Requires 10 numerical characters.

Please go to https://proview.caqh.org/ to ensure your information matches the information you have included in this application.

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