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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.

Required Documents:

Network Participation Request Form W9 Form
Submit your completed request by email, fax or mail:

Email: providernetworkrequests@weatrust.com  
Fax: (608) 276-9119

Mail:    

Network Requests
Attn: Provider Services 
WEA Trust
P.O. Box 7338
Madison, WI 53707-7338

FAQ - Frequently Ask Questions

Q:What happens after I submit a completed Network Participation Request form?

WEA Trust will present your completed Network Participation Request Form at the next monthly meeting of our Network Access and Composition Committee. If approved by the Committee, our Provider Contracting staff will provide you with a network Provider Agreement for your review and acceptance, along with any materials required to complete the credentialing process. If credentialing is required, these materials must be submitted with your signed Provider Agreement; your Agreement will take effect following completion of our credentials verification and review process.

Providers not accepted for network participation will be notified within ten days of the Committee decision.

Q:I submitted a request and have not yet received a response. What should I do?

WEA Trust will review all Network Participation Requests, and will generally provide a response within 60 days of receipt of initial request. If your submitted request is less than 60 days old, please wait to be contacted. If your submitted request is more than 60 days old, please contact our Customer Service team at (800) 279-4090.

Q:My Network Participation Request was not accepted. Can I reapply?

Yes, we will review resubmissions one year after your initial request.


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800-279-4000

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