Forms for Providers

Following are forms for our current and prospective providers necessary for network inclusion, credentialing and recredentialing.

Step 1: Complete The Forms

  • Provider Information Sheet
  • Give us key details about yourself and your organization.
  • We will use the details you provide to update our records and online provider search.
  • CPHP Authorization
  • A signed copy of this form is required with all Credentialing and Recredentialing documents.
  • State of Illinois Documentation
  • State of Illinois Credentialing and Recredentialing packets.
  • Providers use the State of Illinois form for initial credentialing or recredentialing purposes.

Step 2: Submit The Forms To CPHP

Use our contact details, top right, to send your completed forms to us. For additional contact options, such as mailing, visit our Contact page.