Join Our Network

How to apply

You can request an individual contract or join one of our contracted independent practice associations or medical groups.

Credentialing criteria

  • Complete the hard-copy credentialing application, attestation, and release forms
  • Send your completed application with copies of the following documents:
  • Current DEA certificate or coverage plan for the state in which you’re practicing
  • All current state licenses
  • Current professional liability insurance certificate
  • Completed W-9
  • Any explanations to “Yes” answers on your credentialing application
  • Hospital admission/inpatient coverage plan

Submit your application using our hard-copy credentialing application until we transition to the new vendor, CAQH. Find out more about the CAQH transition.

Submit by mail, fax, or email

PO Box 327 - MS 263
Seattle, WA 98111-0327

Fax: 425-918-4766


How to avoid delays

The top reasons for incomplete applications include:

  • Incomplete address, suite number, or phone number
  • Missing tax ID number
  • New contracts are frequently missing the W-9
  • Expired malpractice insurance
  • Incomplete or missing work history or education information
  • Hospital privileges, if applicable

What happens next

Your acceptance is based on application information and network requirements. Please be aware that the credentialing process typically takes 45-60 days. If your submitted application is complete and you’re accepted, you’ll receive a counter-signed contract and start date. For all LifeWise plans, you can’t see members under the contract until you’re officially credentialed. Also, your malpractice insurance must start before credentialing is complete.

For more information

For more information about our selection criteria and credentialing standards, contact Physician and Provider Relations.