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Join Our Network

Thank you for your interest in participating as an IlliniCare Health provider.

Please fill out the form below in order for us to have a better understanding of what services you provide, your location, as well as pertinent information needed for the contracting process.

We will outreach to the contact person listed once a review of your data is completed. If you have any questions or are in need of additional information, please contact the Contracting Department at

Authorization is required if you need to treat an IlliniCare Health member prior to being contracted. Our Medical Management department will review the member’s needs with you and issue an Authorization as needed if a contracted provider is not available to provide the services. Medical Management does coordinate with our contracting department when a non-contracted provider receives an Authorization.

Select Contract Type

If adding a new practitioner to an existing group, please email the Provider Relations team:

Select type of contract. *

Select Provider Type

Select Product

Choose all that apply. *

Provider Information

Number of practitioners. *
Provider must admit to an in-network hospital to join the IlliniCare Health network. If not medical group, out NA.
Please follow format: XXX-XX-XXXX
Required for IlliniCare Health Medicaid and/or MLTSS products. If you do not have a Medicaid number, put NA.
Required for IlliniCare Health Medicare and/or Ambetter products. If you do not have a Medicare number, put NA