Become a Provider
- The form below is NOT an application – providers are not credentialed using it
- Incomplete forms cannot be processed
- Allow 30 days for a response
iCare Health Solutions assesses all requests based on network needs in specific geographic locations. Based on network needs in your area, iCare may forward an application to you. In the event that the network is closed in your area at the time of your request, your provider application request form will remain on file. Please be aware that receiving an application from us and returning it is NOT a guarantee that you will be added to the iCare network.
Correcting Information | Status Requests
Providers have the right to correct erroneous information obtained during the credentialing/ recredentialing process and to request the status of their application in the credentialing process. Any information sent from the provider to iCare during the credentialing/recredentialing process should be sent using one of these methods:
Fax: (305) 675-0565
Requests for status can be sent by fax or email and will be responded to within 2 business days of receipt in the same format as the request was received.
- When ICare Discovers a Discrepancy: Notification of any discrepancies between the information provided and the information obtained from outside sources (i.e., licensing board, DEA, NPDB) will be sent to the provider within 20 days of the discrepancy being identified. The provider must provide corrected information within 10 business days of receipt of the notice.
- When Providers Discover a Discrepancy: If the provider becomes aware of an error in the information provided to iCare, provider must notify iCare of the error within 10 business days of learning about the error. Information sent to correct erroneous information must include documentation from the appropriate authority and a written explanation as to why the information was submitted erroneously.
Information We Share
iCare will share information obtained during the credentialing process, including but not limited to information from malpractice carriers and licensing authorities – but NOT information received from the NPDB, references, recommendations, or peer-reviewed protected information, if any.
Yes, I’m Interested In Becoming an iCare Provider
Please provide all information requested below – incomplete forms cannot be processed.