Providers

Welcome to the Select Health Network provider page. We value your participation and strive to keep you informed by providing easily accessible resources and updates. Please use the links below to find resources and/or additional information about a specific plan. 

If you have any questions, please contact a member of our Provider Relations staff

Contact Us With Questions

Providers

Form Resources


Provider Change Notification

Fill this form out to change information about your company in our database

Online    Downloadable

 

Provider LOA Notification

Let Select know when you'll be taking a leave of absence

Online    Downloadable

 

Provider Termination Notification

When you'd like to terminate your relationship with Select Health Network.

Online    Downloadable

 
2022 Provider Attestation Form

This document attests to your organization’s yearly required compliance, reporting and training.

Downloadable

 

Out of Network Exception Request Form

This document is for Saint Joseph County Government and School City of Mishawaka members. 

Downloadable

 

Plan Your Care Select English

View this form to post for patients to navigate their care

Online

 

Plan Your Care Select Spanish

View this form to post for patients to navigate their care

Online

 

Plan Your Care SJHS English

View this form to post for patients to navigate their care

Online

 

Plan Your Care SJHS Spanish

View this form to post for patients to navigate their care

Online