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).
- Banner Health Network | Provider Interest Form
- AzAHP Facility and Practitioner Forms
- AzAHP Organizational/Facility Application
- AzAHP Practitioner Data Form
- AzAHP Group Roster Form (use for 10 or more practitioners under one TIN)
- AzAHP Provider Credentialing/Re-Credentialing Tips
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.
- Please use the appropriate AzAHP form as indicated in the type of request being submitted:
- 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
- Submit AzAHP Organizational/Facility Application
- Submit to: BUHPDataTeam@bannerhealth.com
- 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
- Contract/TIN
- Submit email or letter to ProviderLegalNotice@bannerhealth.com
- Change of Ownership
- Submit email to ProviderLegalNotice@bannerhealth.com
- Practitioner
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Location
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
Updates/Changes
- Panel Change - Open or Close Panel
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Service Address Change – (no new organizational NPI or TIN)
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Practitioner Name Change
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Billing Contact
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Billing Name or Pay-to Address
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Credentialing Contact
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Specialty
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Practitioner Type
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
- Other (AHCCCS Reg Number, NPI, etc.)
- Submit AzAHP Practitioner/Practice Change Form
- Submit to BUHPDataTeam@bannerhealth.com
Tips and FAQs
- Register with AHCCCS Administration as a provider for AHCCCS and maintain it throughout the term of this agreement. B – UHP is not responsible for payment to non-registered providers. Follow all terms of your contract and adhere to B – UHP’s Provider Manual and Behavioral Health Manual, when applicable. The Provider Manuals are located at https://www.banneruhp.com.
- Notify B – UHP Provider Contracting at least 30 days before the effective date of any changes in tax identification number, services, the organization’s legal name change, or any requested changes to your contract.
- B – UHP will return the executed contract once the signed contract is completely loaded in B – UHP systems.
- Please note that submission of an AzAHP form does not guarantee that a provider contract will be offered to your practice or organization.
Q. How do I know if I am currently contracted with Banner – University Health Plan (B – UHP)?
A. Contracted providers are given a copy of their contract after completion of credentialing and loading into B – UHP systems. If you need a copy of your contract, please email UAHNContractingMailbox@bannerhealth.com. Include the name of your organization and tax identification number in your email.
Q. How long does the B – UHP credentialing process take?
A. Once a complete clean AzAHP form is received, the credentialing process and loading into systems can take up to 60 days.