Contact Coventry

• Home
• Contact Coventry
• Provider Network Nomination

Provider Nomination

Thank you for your interest in Coventry's Workers' Comp Networks.  If you would like to nominate a provider to become part of our networks, or if you are a provider and would like to apply to become part of our networks, please fill out the fields in the form below.

Coventry Integrated Network

MetraComp

Nomination Request

* Required Fields

error

• *This is Nomination for:

  General network
  New York MetraComp network
  

• *Physician First Name
• *Physician Last Name
• *Phone number
• Fax number
• *Email Address
• *Primary Office Address Line 1
• Primary Office Address Line 2
• *City
• County
• *State Select Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• *Zip Code
• *Office Contact
• *Degree of Provider
• *Specialty
• Is the provider a member of a group practice? Yes No
• Group Name (required if the provider is a member of a group)
• *Tax ID
• National Provider Identifier(NPI)
• CAQH ID Number(if applicable)
• Submit

MetraComp

Thank you for your interest in MetraComp, Inc.  MetraComp is the largest New York State certified PPO created specifically with workers' compensation in mind.  If you would like to nominate a provider to become part of the MetraComp network, or if you are a provider and would like to apply to become part of the MetraComp network, please Click Here. >>