Update Your Provider Directory Listing

Your provider directory listing is the most valuable communication tool you have to communicate with Alliance participants.

Use this .pdf form or .doc form to report any changes to your current provider(s) or organization information including:

• Name change for the organization
• Tax ID change
• Address and location changes
• Contact information or other changes

Please allow us at least two weeks to make and incorporate your change into the provider directory. Changes specified as “effective immediately” will be made within two weeks. To review your changes, visit our online directory and search for your listing. 

Add New Providers

Use this .pdf form or .doc form to add a new provider to an organization that currently holds an agreement with The Alliance. 

If credentialing is required for the new practitioner, we will send the practitioner a notice within 60 – 90 days after receiving the completed form and other required information.

Fee Analysis Request Form 

Request a custom fee analysis  for services commonly billed by your practice.

If you have questions about this form, please contact providerservices@the-alliance.org.

Becoming an In-Network Alliance Provider

If you are interested in becoming an in-network Alliance provider and have not already received an agreement, please complete and return this form (pdf) or (doc) and follow the link below for more information.