Physician Application Form

Below, please find a complete membership packet that will assist PMC in your enrollment process. Please fully complete the packet with all the information requested. Failure to do so may delay the contracting process for the various health plans. Once the membership information is received, along with the $1,500 membership fee, the contracts will be submitted to the health plans.

PMC does not determine the length of time it takes each health plan to process contracting paperwork. It is recommended the practice review and/or confirm an effective start date with each health plan before scheduling patients. Please keep in mind contracting may take up to 180 days.

PMC Responsibilities

• Process PMC membership application
• Submit signed contracts to the health plans within 3-5 business days of receiving the packet
• Confirm within 30 days the contract was received, and the health plan is processing

Practice Responsibilities

• For status updates on contracting, please utilize the given list to contact the health plan directly
• Review and/or confirm effective date with the health plans before scheduling those patients
• Contact PMC membership if there are any questions after the contracts are submitted to the health plan

If you have any questions, please email PMCMembership@medicaladvantage.com or call (800) 594-6115.