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.

Providers seeking a contract should submit a Provider Interest Form and AzAHP forms (located below), which should be attached to the Provider Interest Form. The Provider Interest Form located  at:

If you have questions or need to provide additional supporting documentation, please email  Please allow 120 days before requesting status.  

AzAHP Facility and Practitioner Forms

Complete AzAHP forms below.

*Submit forms with Provider Interest Form only after AHCCCS Registration is completed.

 AzAHP Organizational/Facility Application

 AzAHP Practitioner Data Form

 AzAHP Practitioner/Practice Change Form

 AzAHP Provider Credentialing/Re-Credentialing Tips

 AzAHP Group Roster Form (use for 10 or more practitioners under one TIN)

*Important Notice: Effective 10/01/2022, requests for updates must be submitted on the most current AzAHP Practitioner / Practice Change Form and are required to be sent to

*Disclaimer: Please specify the action for the request. Include the documents requested on page 1 of the AzAHP form. Without the necessary documents, the processing will be delayed.

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.

Instructions for Behavioral Health Programs - Exhibit E

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