Add/Terminate a Practitioner

I want to required *

If you are a provider who is part of an existing contracted medical or behavioral health entity, use this online contracted enrollment form to enroll a new provider.

If you are adding multiple practitioners, please utilize this roster: Alabama Prov Add Roster

PCP required *
Hospitalist required *
Allied Provider? required *
Primary Practice required *
Accepting New Patients required *
Print in Directory required *
Handicap Access required *

Providers must give Ambetter of Alabama notice of voluntary termination following the terms of their participation agreement. Ambetter of Alabama must notify affected enrollees covered under the terminating agreement at least 30 calendar days prior to the effective date for any termination.

Alabama Term Roster

Note* If you have already completed your application with CAQH, please ensure that you have authorized Centene to access your data. This can be done by calling CAQH at (888) 599-1771 or by logging into your account and adding Centene to your list of authorized plans. Using the CAQH Universal Credentialing DataSource does not grant participation or constitute applying for participation.

Termination requested by