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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

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 Health Plan of Illinois, Inc. to evaluate participation in our network and is not representative of an application of a legal agreement.

Provider Credentialing Rights

During the credentialing process, Meridian obtains information from various sources to evaluate your application. Ensuring the accuracy of this information is critical, so please review and provide any corrected information as soon as possible. You also have the right to review the status of your credentialing or recredentialing application at any time by contacting our Provider Relations team.

Step 1 - Provider Type

Select your provider type. required *

Step 2 - Product Interest

Select the products you want to participate in. required *

Contract Type *

Please indicate if you are requesting a new contract or looking to amend an existing contract. Visit the Provider Updates page to update rosters, change addresses, and make other demographic updates.

Step 3 - National Identifiers

Step 4 - Illinois Medicaid Number

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.

Please verify below that your Illinois Medicaid Number is currently active. 

If your Illinois Medicaid Number is NOT active, this will result in a denied application for participation.

Please verify that your Illinois Medicaid Number is currently active. required *

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.

Step 5 - Practice Contact Information

Step 6 - Practice Information

Applying as: required *
Is this your primary specialty? required *

Step 7 - Credentialing Contact Information

Step 8 - Documents

Required Documents

Please upload the following required documents.

  • Commercial Certificate of Insurance

Optional Documents

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

Questions and Support Resources

Providers with contracting-related questions or issues completing this form may contact our Contracting Department at ILJoinOurNetwork@centene.com. Current providers are also encouraged to review our Provider Relations support options for assistance.