Forms
Significa Insurance Group (Significa) makes many of our forms available for your access through our Web site. You can download the files (in Adobe® Acrobat® format) from this page and print the forms for completion. To read these files you must have the Adobe® Acrobat® Reader™ installed on your computer. If you do not have it installed, you may download the program by clicking the icon below.
Significa Provider Information
(User ID and Password Required)Credentialing Information
- MD, DO, DMD, DDS, OD, DPM, and DC Credentailing Requirements
- Non-Physiscian Behavioral Health Provider Credentialing Requirements
- Physician Extender/Therapist Data Requirements
- Recredentialing Form
- Provider Application Form*
- Authorization for Release of Information
Policy and Procedure
- EHP Network Option - Provider Office Manual
- EHP Significa Network Option - Provider Office Manual
- Payer Listing (claims/benefits/preauthorization information)
- Out of Panel Referral Form
*The PA Standard Application is accessed by permission of the Pennsylvania Medical Society at their website.
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