Contract Opt-In Forms

If you have questions about any opt-in forms, please e-mail jroach@pcot.org.

Aetna MA opt-in

Aetna Midlevel agreement

Aetna PPO opt-in

Aetna product list

Alliance WC opt-in

Ambetter commercial exchange contract opt-in

Amerigroup Medicare Advantage opt-in

CorVel contract opt-in

First Health-Coventry opt-in letter-Revised 2015

Fresenius Health Plan MA opt-in

Galaxy opt-in

Health Spring MA (PPO) contract (starts 1/1/2021)

Health Spring Medicare Advantage (HMO only)

HealthSmart ACCEL

HealthSmart PPO-revised 2012

Humana Commercial opt-in

Humana Medicare HMO opt-in

Humana Medicare PPO opt-in

Independent Medical Systems (IMS) opt-in

Managed Care Strategies (Three Rivers) opt-in

Molina opt-in letter

Multiplan Managed Medicaid contract opt-in

Multiplan STAR Kids opt-in form

Nexcaliber opt-in

Provider Select-Strategies contract opt-in

Rockport workers comp opt-in

STAR+Plus opt-in (Cigna Healthspring only now)

Superior health plan contract opt-in

Texas Children's Health Plan (TCHP) STAR KIDS opt-in

Tricare OPT In-Out Letter

Tricare Revised Delegated Provider Physician and Dentist Application SOU...

Tricare opt-in form

UHC Medicare Advantage opt-in

UHC commercial opt-in

USA Managed Care opt-in

prime health services contract opt-in