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Agent Contracting Checklist

If you would like to contract with us please fill out the form below.

Personal Information:
Name*
First Last
Email*
Phone Number*
NPN:*
Medicare Advantage:
Arizona:
- UnitedHealthcare
- Humana
- Aetna
- University of Arizona Health Plan
- Health Choice
- Cigna
- Blue Cross Blue Shield of AZ
Arkansas:
- UnitedHealthcare
- Humana
- Aetna
Colorado:
- UnitedHealthcare
- Humana
- Aetna
New Mexico:
- UnitedHealthcare
- Humana
- Amerigroup
- Blue Cross Blue Shield of NM
- Molina Healthcare
Texas:
- UnitedHealthcare
- Humana
- Blue Cross Blue Shield of TX
- Molina Healthcare
Medicare Supplement
Arizona:
- UnitedHealthcare
- Humana
- Aetna
- Mutual of Omaha
- Cigna
- Blue Cross Blue Shield of AZ
Arkansas:
- UnitedHealthcare
- Humana
- Aetna
- Mutual of Omaha
- Cigna
Colorado:
- UnitedHealthcare
- Humana
- Aetna
- Mutual of Omaha
- Cigna
New Mexico:
- UnitedHealthcare
- Humana
- Aetna
- Mutual of Omaha
- Cigna
- Blue Cross Blue Shield of New Mexico
Texas:
- UnitedHealthcare
- Humana
- Aetna
- Mutual of Omaha
- Cigna
- Blue Cross Blue Shield of Texas
Ancillary
GTL - Hospital Indemnity
- Arizona
- Arkansas
- Colorado
- New Mexico
- Texas
Dental Insurance
- Yes
- No
Required Documents
Voided Check
Max. file size: 64 MB.
W-9
Max. file size: 64 MB.
E&O
Max. file size: 64 MB.
Current Resident License
Max. file size: 64 MB.
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