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It’s time to choose your Managed Care health plan! Open Enrollment is October 1 – December 15. Click here for more information and to complete your annual open enrollment.

Attention all MSCAN/CHIP Members: Click here to find a list of 2026 Member Workshops.

Contract Request Form

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Provider Request Information (please select all that apply) required *

Which product line(s) are you requesting to participate in?

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Contact Information

Contact Name

Provider Information

(Must match W-9)

Provider Identification Numbers

Provider Type

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