Credentialing Forms
For newly contracted providers, please email forms to AzCHpotentialprovider@azcompletehealth.com. For existing network providers, please email forms to AzCHProviderData@azcompletehealth.com.
- Credentialing Check List and FAQs (PDF)
- Disclosure of Ownership Fillable Forms and Instructions (PDF)
- Facility Credentialing and Recredentialing Application (PDF)
- Non Delegated Group AzAHP Roster
- Non Par Checklist Template (PDF)
- Practitioner Data Form (PDF)
- Practitioner Practice Change Form (PDF)
- Transportation Demographic Form (Medicaid) (PDF)