join our network



We’re doctor-sponsored, nonprofit and on a mission to change healthcare in Connecticut. We can’t do it alone! Together, we can accomplish our mission. Everything you need to partner with us is below. If you have any questions, please call our Network Partnerships team at 1-855-458-4928.

Provider Forms

Complete the appropriate Data Form and fax it to the # listed on the form, or mail to:

HealthyCT Provider Partnerships
35 Thorpe Ave., Suite 104
Wallingford, CT 06492

We work with CAQH to initiate the credentialing process. Please keep your CAQH application up to date with your current practice information.


  • Individual providers are defined as those who provide us with a social security number or tax identification number (TIN) that is associated to their name alone.
  • Group Providers are defined as those who provide us with a tax identification number (TIN) that is associated to either their name as a PC, LLC, Partnership or to a group business name. All eligible providers within a tax identification number (TIN) will be considered participating.
  • If you are an individual provider and a member of a group practice, you must sign an individual agreement in addition to the group agreement if you wish to be participating in both practices. A separate agreement is required for each tax identification number (TIN) which you bill under.
Fee Schedules

Please contact us for a representative fee schedule specific to your specialty.