Request For Network Participation:

Providers wishing to become participants in our preferred network should follow the steps listed in the Request for Network Participation questionnaire. Doing so will provide the Midlands Choice contracting department with information needed to forward the appropriate contract, if necessary. Applications are required for hospitals and ancillary facilities.

To more quickly identify your needs and better facilitate your request, we will first ask you a short series of questions about your practice or facility.

Is this request for a hospital or an ancillary facility (e.g. Alcohol/Drug Center, Ambulance Service, Ambulatory Surgery, Dialysis Centers, Durable Medical Equipment, Home Health Care, Hospice, Hospitals, Infusion Therapy, Laboratory, Prosthetics/Orthotics, Radiology Center, Sleep Disorder or Urgent Care)?