Provider Nomination Form

Provider Nomination Form

To receive the highest level of benefits your group plan allows, you must receive your healthcare from a First Choice Health PPO Network (FCH PPO) preferred provider. If your provider is not contracted with FCH PPO, you may want to ask whether s/he is interested in applying for membership. We would be happy to process your request if you would please complete the following information and send it to us. Our address and fax number is:

First Choice Health
600 University Street, Suite 1400
Seattle, WA 98101
Fax: (206) 268-2941

First Choice Health PPO Network (FCH PPO) appreciates your nomination of healthcare providers for membership. All applications are processed to ensure compliance with network membership criteria and credentialing verification. This credentialing process may take several weeks (average is six to eight weeks) and membership is subject to approval. We appreciate your patience.

Please be aware of our Network Closure for select specialties in Washington State.

Provider Information

5/22/2019