If you are not registered with CAQH and would prefer to join the Keystone First Community HealthChoices provider network via our paper process, please complete and return the documents listed below.
- Application Checklist for Organizational Providers (PDF)
- Organizational Provider Credentialing Application (PDF)
- Application Checklist for Practitioners (PDF)
- Credentialing Application (Pennsylvania Standard Application) (PDF)
- Home- and Community-Based Services (HCBS)/Long-Term Services and Supports (LTSS) application checklist (PDF)
- Home- and Community-Based Services (HCBS)/Long-Term Services and Supports (LTSS) credentialing application (PDF)
- Ownership and Control Disclosure Form (PDF)
Completing and/or submitting the Keystone First Community HealthChoices credentialing application does not guarantee participation in the provider network.
Note: If you are joining an existing Keystone First Community HealthChoices participating group or health care facility and you would like to become a participating provider, please use the credentialing application (PDF).