CHD Provider Relations: Contracting

If you are a new independent provider or group and are interested in contracting, please email CHDProviderRelations@eCommunity.com.

If you are an employed provider, please contact your Provider Relations Analyst located in the Service and Education section.

Helpful Forms

• Provider Contracting Questionnaire
• Facility/Ancillary Contracting Questionnaire
• Blank W-9
• CMS 1500 Form (sample)
• UB-04 Claim Form (sample)

Frequently Asked Questions

What is the difference between individual contracting and group contracting?

Individual contracts are meant for those providers working as sole practitioners. Group contracts are best suited for practices with two or more providers who will accept the same plans.

What item(s) or requirements are needed to begin the contracting process?

A completed Provider or Facility/Ancillary Contracting Questionnaire Form is the first step necessary in beginning the contracting process (see links above). The Provider Contracting Questionnaire can be used for both individuals and groups seeking contracting. The Facility/Ancillary Contracting Questionnaire Form is solely used for facilities/ancillaries.