Join the Network

Thanks for your interest in becoming an Ancillary Care Service provider. Please have the following documents and information available prior to starting your application.

  • Provider specialty
  • Tax ID
  • W-9 (scanned copy)
  • State credentialing application
  • State license (scanned copy)
  • Certificate of malpractice insurance (scanned copy)
  • DEA and DPS numbers if applicable (scanned copy)
  • Listing of service locations
  • Contact information, including name, address, phone, fax, and email for the following:
    • Facility contact
    • Billing contact
    • Corporate contact
    • Contracting contact

Click here to begin the e-Contracting application.

If you experience any issues during the process,
please contact us via email at
or toll-free at 844-516-3335 ext. 86918

Alternatively, you may download the provider application,
complete the form, and mail it to:

Provider Relations
Ancillary Care Services
5429 Lyndon B. Johnson Freeway, Suite 850
Dallas, TX 75240

For additional information, please see our Provider FAQs
or contact our Provider Service Center.