Join Our Illinois Provider Network | Ambetter of Illinois

 

Join Our Network

Thank you for your interest in participating in the Ambetter of Illinois network! If you would like to receive more information on becoming a provider within our network or would like to receive a contract, please contact us or call 1-855-745-5507.

Note: Completion of this form does not guarantee inclusion into the provider network. It generally takes 20 business days to analyze the form and make a determination if the contract process will commence. Failure to accurately complete the form will significantly extend this processing time. 

We will outreach to the contact person listed once a review of your data is completed. If you have any questions or are in need of additional information, please contact the Contracting Department at ILJoinOurNetwork@CENTENE.COM. 

Step 1 - Provider Type

Select your provider type. * required *

Step 2 - Product Interest

Select the products you want to participate in.*

Step 3 - National Identifiers

Step 4 - Illinois Medicaid Number

If applicable to your Product Interest, log into your IMPACT account to verify that your Illinois Medicaid Number is active. If your Illinois Medicaid Number is NOT active, this will result in a denied application for participation in Medicaid products.

Please verify below that your Illinois Medicaid Number is currently active. 

If your Illinois Medicaid Number is NOT active, this will result in a denied application for participation.

If applicable to your Product Interest, provide your Medicare Identifier (Medicare ID)

If your Medicare Identifier is NOT active, this will result in a denied application for participation in Medicare products.

Step 5 - Practice Contact Information

Step 6 - Practice Information

Applying as: required *
Is this your primary specialty? required *

Step 7 - Credentialing Contact Information

Step 8 - W9 Form

Click to download a blank W9 form (PDF).