In an effort to ease the administrative burden on providers, MCOs have approved a shared roster template. Providers can complete the roster template below and submit the same document to all MCOs. See where to submit to each MCO below.

Note from MCOs on updating Provider Rosters, 1/30/19:
Once you’re credentialed, you’re good for 3 years - you only need to update the provider roster if there are changes. In order to process correctly in system, we need to rosters updated as you have changes. We would accept monthly, but would rather be notified of changes as they come. If we don’t have one of your providers loaded for the correct facility, then run the risk of being rejected. Let the MCOs know as soon as you have someone new coming on.

Amerigroup
waopsrequest@amerigroup.com

CHPW
provider.changes@chpw.org

Coordinated Care
contracting@coordinatedcarehealth.com

Molina
MHWProviderInfo@MolinaHealthcare.com