For more information on how to become a participating Provider with Unison Health Plan, please complete the required fields below with your first name, last name, telephone number with area code, and e-mail address. Click the Submit button. You will receive a message saying that a representative will contact you shortly. We look forward to speaking with you! If you are already a Unison Health Plan provider and have a question or need assistance, please call the Provider Services Department at 800-600-9007.

Name:
Practice Name:
Specialty:
Contact Person:
Phone Number:
E-mail:
Address:
City:
State:	- select one - AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code:
County:
Do You Currently Accept Medicaid:	YesNo
Do You Currently Accept Medicare:	YesNo
Please select the state and the LOB to Enroll:
Enrollment State:	- Select a State - Arkansas Delaware Mississippi Ohio Pennsylvania South Carolina Tennessee Washington, D.C.
Enrollment LOB:
*If you would like to set up a new account, or access your current account please select the account information option under the For Providers tab. **If you are already a Unison Health Plan provider and have a question or need additional assistance, please contact your Provider Relations Representative, or the Provider Services Department at 800-600-9007. Please check this box and proceed only if you are a non-participating Unison provider wishing to contract with Unison Health Plan.

By submitting your information to Unison Health Plan using this page, you will not automatically be enrolled as a Unison Health Plan participating provider. In order to participate with Unison Health Plan, the provider must sign a Unison network participation agreement and complete Unison Health Plan's credentialing process. This is just an invitation for you to show your interest in discussing the benefits of becoming a Unison Health Plan participating provider.