Become a Provider
NOTE: Please note that this is not an application. Providers are not credentialed using this form.
Please be sure to complete all information. Incomplete forms cannot be processed.
Providers have the right to correct erroneous information obtained during the credentialing/ recredentialing process and to request the status of the application in the credentialing process. Requests for status can be sent by fax or email and will be responded to within two (2) business days of receipt in the same format as the request was received. Notification of any discrepancies between the information provided and the information obtained from outside sources (i.e., licensing board, DEA, NPDB) will be sent to the provider within twenty (20) days of the discrepancy being identified. The provider must provide corrected information within ten (10) business days of receipt of the notice. If the provider becomes aware of an error in the information provided to iCare, provider must notify iCare of the error within ten (10) business days of learning about the error. iCare will share information obtained during the credentialing process, including but not limited to information from malpractice carriers and licensing authorities but not information received from the NPDB, references, recommendations, or peer-reviewed protected information, if any.
Any information sent from the provider to iCare during the credentialing/recredentialing process should be sent by fax to: (305) 675-0565 or email at: firstname.lastname@example.org. Information sent to correct erroneous information must include documentation from the appropriate authority and a written explanation as to why the information was submitted erroneously.
iCare Health Solutions assesses all requests based on network needs in specific geographic locations. Based on network needs in your area, iCare may forward an application to you. Please be aware that returning a complete application is not a guarantee that you will be added to the iCare network. In the event that the network is closed in your area at the time of your request, your provider application request form will remain on file.