Join Us

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.

AzAHP Facility and Practitioner Forms

Obtain AzAHP forms below.

*Submit forms only after AHCCCS Registration is completed.

 AzAHP Organizational/Facility Application

 AzAHP Practitioner Data Form

 AzAHP Provider Credentialing/Re-Credentialing Tips

Providers seeking a contract should submit AzAHP forms to Provider Contracting:

Email AzAHP forms

Please allow 180 days before requesting status.

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.

Instructions for Submitting Information with the Letter of Interest (For Behavioral Health Providers)

Contract-related Inquiries and Contract Status:


Please include the name of your organization and tax identification number in your email.

Providers with an existing contract requesting a termination or change to a practitioner or location should submit their request in writing. An AzAHP form is not required.

Please submit requests to:

Please submit an updated facility and provider roster with current AHCCCS-registered locations and providers with their NPI(s) and TIN(s).

Providers with an existing contract requesting to add a new practitioner to their contract should submit an AzAHP form.

All practitioners 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.

Tips and FAQs