New Provider Network Participation Requests
Thank you for your interest in joining the WEA Trust Provider Network.
Is your organization already in-network, but needs to add a provider, update your provider directory listing, or modify your existing contract? Please use our Provider Update Form to report any changes to your current provider(s) or organization, including:
- Federal tax ID change
- Legal business name change
- Billing/correspondence contact change
- Practitioner change
- Service location change
- Practice closure
If your organization is not yet contracted for participation, our Network Participation Request Form is the first step toward joining the WEA Trust Network.
Please note that completion of our Network Participation Request Form and/or credentialing application does not guarantee acceptance in the WEA Trust Network. All requests must include a current W-9 and a listing of your 10 most frequently billed codes with fees. Incomplete forms will not be considered.
Network Participation Request Form