BHN

Update Practice Information

Join Our Network or Update Your Information

Join Our Network

Thank you for your interest and participation in Banner – University Health Plan’s (B – UHP) Network. We are committed to maximizing the member and provider experience in meaningful ways.

Please use the guide below to assist your practice or care organization to become a participating provider and provide guidance during and after the contracting process.

Providers Seeking a Contract

Submit a Provider Interest Form and attach the required AzAHP forms (located below). 

Attach the appropriate AzAHP form(s) to the Provider Interest Form only after AHCCCS Registration is completed.  Include the documents requested on page 1 of the AzAHP form with your Provider Interest Form. Without the necessary documents, a contracting decision cannot be made.

 

Behavioral Health Providers

Behavioral Health providers should include a summary description of programs, including target populations and age categories, specific models of care/therapies used, along with frequency of programming treatment and complete Exhibit E for each location. See link to instructions and form below.

If you have contract-related inquiries, questions, or need to provide additional supporting documentation, please email BPAProviderContracting@BannerHealth.com. Please allow 120 days before requesting status on a new contract.  Please include the name of your organization and tax identification number in your email.

Providers with an Existing Contract

Please notify B – UHP at least 30 days before the effective date of any changes or updates.

Adds

  • Add a Practitioner
    • Submit AzAHP Practitioner Data Form (only after AHCCCS Registration is complete)
    • Submit to: BUHPDataTeam@bannerhealth.com
    • Practitioner must be registered with CAQH. The primary contact information in CAQH must be current to avoid credentialing delays. Practitioners must also re-attest to the validity of their information quarterly. 
  • Add a Location with a New Organizational NPI
  • Add a New TIN
    • Submit a new Provider Interest Form – see link above and
    • Attach an AzAHP Organizational/Facility Application 
  • Add a Product: B – UFC/ACC, B – UFC/ ALTCS, Banner Health Network, Banner Medicare Advantage HMO D-SNP (formerly known as Banner – University Care Advantage)
    • Submit a new Provider Interest Form – see link above
    • If you are not already contracted for B – UFC/ACC, B – UFC/ALTCS, and Banner Medicare Advantage HMO D-SNP, attach an AzAHP form – see link above
    • Indicate which Products you are requesting to add in the Comments field

Terminations – include the termination effective date

Updates/Changes

Related

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