Primary Practice:
Medicare numbers are not currently required for UPMC Dental Advantage applicants to accept our Medicare product.
Secondary Practice:
Medicare numbers are not currently required for UPMC Dental Advantage applicants to accept our Medicare product.
Providers that utilize CAQH may enter their CAQH provider ID in the space below. After review of the participation request submitted, UPMC Health Plan will retrieve the provider’s CAQH application for credentialing.
CRNPs, CNMs, and PAs: Please attach a copy of the collaborative agreement to the CAQH application documentation.
By submitting this request for participation, I hereby attest that all of the information I am about to submit is true and accurate to the best of my knowledge.
I understand that any information provided pursuant to this attestation that is subsequently found to be untrue and/or incorrect
could result in my termination from UPMC Health Plan should I be approved.