Please complete this form to join the Coventry Workers’ Compensation, Coventry Auto Injury or First Health network.
If you already work with us and need to update your Tax ID (TIN), do not use this form. Instead, log in to NaviNet or the electronic transaction vendor that you use.
If you need more information about our application and credentialing process, use the link below. You also will find information on the Council for Affordable Quality Healthcare's (CAQH's) ProView® and ProviderSource™ (for Washington State licensed practitioners).
Information about application and credentialing process
As a practitioner, you have the right to correct any information obtained during the credentialing process by working directly with the reporting entities.
All fields marked with a RED asterisk (*) are required.