Adding Practitioner to Contract

Process Steps

If you wish to add a practitioner to a current contract please follow these steps:

Please use this form to add a provider to your contract.

All licensed practitioners must be credentialed prior to providing services to CCHP members. (MD-DO-DPM-DC-APNP-CRNA-CNM-PhD-PsyD-LPC-LCSW-LMFT-CSAC-BCBA-AuD)

To participate in our BadgerCare product, applicants must be certified with Wisconsin Medicaid. To begin the credentialing process, CCHP uses the CAQH (Council for Affordable Quality Healthcare's) ProView™ application, which is available online.

  1. Already registered? Email your completed Practitioner Request Form to
  2. Not registered? Register with CAQH at and complete the CAQH credentialing application. Notify CCHP when you have registered with CAQH by emailing practitioner name, CAQH number, group name and individual NPI number to

 While completing the CAQH application, the following required information must be included in order to begin the credentialing process with CCHP:

  • All information must be current and CAQH must be attested with current date
  • All dates (work/employment/education) must include month and year
  • Employment history for the last five years – must include start and end dates MDs/DOs must include complete history starting from medical education
  • Gaps in employment greater than 60 days must be explained
  • Hospital privileges must include hospital name, affiliation status, start date (MM/YY)
    If in process, must include covering physician’s name, hospital affiliation, status, start date (month and year)
    If no hospital privileges, need to explain admitting arrangements, if through a covering physician, include hospital name, affiliation status and start date (MM/YY)
  • APNP’s / CRNA's are required to include a copy of their Collaborative Agreement, Specialty and/or Scope of Practice
  • A copy of professional liability insurance face sheet (must include dates and incident/aggregate dollar amounts, amounts must be minimum $1 million/$3 million)


If you have any questions about our credentialing process, please call our credentialing department at 844-229-2776. You may also email questions to