Credentialing Forms
For newly contracted providers, please email forms to AzCHpotentialprovider@azcompletehealth.com. For existing network providers, please email forms to AzCHProviderData@azcompletehealth.com.
- Credentialing Check List and FAQs (PDF)
- Delegated Group AzAHP Roster (XLS)
- Disclosure of Ownership Fillable Forms and Instructions (PDF)
- Organization/Facility Credentialing and Recredentialing Application (PDF)
- Non Delegated Group AzAHP Roster (XLS) (for 10 or more practitioners)
- Non Par Checklist Template (PDF)
- Practitioner Data Form (PDF)
- Practitioner/Practice Change Form (PDF)