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)