Paper Credentialing

If you are not registered with the Council for Affordable Quality Healthcare (CAQH)* and would prefer to join the Keystone First CHC provider network via our paper process, complete and return the documents linked below. If you have any questions, please call 1-800-642-3510, option 1.

*CAQH credentialing does not apply to HCBS and LTSS providers. HCBS and LTSS providers should complete our paper application process.


HCBS and LTSS providers

HCBS and LTSS provider requests for a contract can be sent to Please include a copy of your W-9, counties that you cover, and services that you provide. A completed contract is required in order to start the credentialing process.

Physical health practitioners

Fax all applicable items on the application checklist, including IRS Form W-9 (PDF), to 1-877-759-6221. Or, you may scan your signed documents and submit them by secure email to Please be sure to scan the application checklist and fax or email it along with the documents.

Organizational providers

Completing and/or submitting the Keystone First CHC credentialing application does not guarantee participation in the Keystone First CHC provider network.

Note: If you are joining an existing Keystone First CHC participating group or health care facility and you would like to become a participating provider, please use the credentialing application (Pennsylvania Standard Application) (PDF).

Documents and information