Skip to Main Content
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how

Meridian Provider Network Intake Form

Thank you for your interest in joining our provider network. Begin our contracting process by completing this form with essential information about your practice and product interests. Please be sure to fully complete the form and submit all requested documents; failure to do so will delay processing time.

Requests are processed in the order they are received. A member of our Provider Network & Development team will contact you about a decision to move forward with the contracting process within approximately 20 business days.

Please note: Completion of this form does not guarantee a contract offer. The information you provide is used by Meridian to evaluate participation in our network and is not representative of an application of a legal agreement.

(All fields are required unless otherwise noted.)

Type of Contract Request required *

Provider Type

Select your provider type.

Provider Type required *

National Identifiers

Product Interest

Select the products you want to participate in.

Product Interest required *

llinois Medicaid Number & Verification

To participate in our network of providers for the Meridian Medicaid Plan and YouthCare, you must have an active Illinois Medicaid Number. Log into your IMPACT account to obtain your Illinois Medicaid Number and verify that it is active.

Verification

Please verify that your Illinois Medicaid Number is currently active. If your Illinois Medicaid Number is not active, your application to join the provider network will be denied.

Verification required *

Medicare Identifier

To participate in our network of providers for Wellcare or the Medicare-Medicaid Plan, you must have an active Medicare Identifier (Medicare ID). If your Medicare ID is not active, this will result in a denied application for participation in Medicare products.

Provider/Practice Contact Information

Practice/Provider Specialty

Please tell us what credentialed service and/or specialties you are applying for participation in our provider network (e.g., primary care provider, dermatologist, audiologist, physical therapist, etc.).

Contact/Credentialing Representative Information

Required Documents

Please upload the following required documents.

  • Commercial Certificate of Insurance

Optional Documents

Please upload any other documents (i.e., certificates, licenses, CLIA, etc.) that may facilitate faster processing of your application.

National Identifiers

Contact Information of Person Requesting Amendment

Description of Contract Amendment Request

Briefly describe how you are looking to amend your contract. For complex changes to existing contacts or related questions, contact our Contracting Department at ILJoinOurNetwork@centene.com.

Please visit the Provider Updates page to update rosters, change addresses, and make other demographic updates.

Still not finding what you need? Contact our Contracting Department for contracting-related issues at ILJoinOurNetwork@centene.com. Current providers may also view our Provider Relations support options for assistance.