Credentialing Sign-Up, Add Provider to an Existing Group

Thank you for your interest in our lactation provider Group Credentialing Service to add a provider. If you already have a group NPI established and you’d like to add a new provider to your group, this is the service for you! If the provider is not already in network with insurance, we can help them get in-network as an individual.

This service adds a provider to the databases and insurance companies you choose. (You’ll be able to discuss specifics with your credentialing specialist.) Please complete the contact information below with the primary provider responsible for the group. After submitting this information, you’ll be directed to a page to complete payment.

Primary Contact Information

Please enter the contact information of the primary person responsible for the group.  This is usually the owner of the group practice or a person designated to handle credentialing tasks on behalf of the group.  This person will be the primary contact responsible for payment and for this service and receive all email and phone contact with questions and/or service updates, unless direct contact with the provider is necessary.

Primary Contact Name:*
Organization Name:
Primary Contact E-mail:*
Primary Contact Phone:*
Contact Information for Provider
Please enter the contact information for the provider being added to the group.
Name of Provider Adding to Group*
New Provider E-mail:*
New Provider Phone:*
Please select one or two payors (insurance companies) for which you'd like to add a new provider.
Select Product:*
Which payors?*
After completion of all required fields, agreeing to our terms, and upon clicking, "Submit and continue to payment," you will be directed to PayPal to complete payment processing.  Once this form AND payment are completed, you'll receive an email from us with further instructions for moving forward with this credentialing service, along with contact information for your assigned Credentialer.  If you have any questions or concerns throughout this process, please feel free to email [email protected].
TERMS: I understand that Lactation Practice and its credentialing specialists will process this contracting request to the best of their ability. The contracting process with insurance companies is not a certainty and occasionally insurance companies deny requests for contracting. Lactation Practice will work on your behalf, however, we make no guarantee that the insurance company(ies) will accept the application.*