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Provider Nomination

Thank you for your interest in the Coventry's Workers' Comp Network. Please complete the provider nomination form below.

If you have already completed the form and would like to check on the status on your application, please call 1-800-937-6824.

Coventry Integrated Network

MetraComp

Nomination Request

* Required Fields

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• *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

• *Are you a Workers' Comp provider?

  Yes
  No
  

• *This is Nomination for:

  General network
  New York MetraComp network
  

• *Specialty:

  
  
  

  • Panel Closed for Mental Health Providers
    Non Mental Health Providers call: 1-800-833-7423, Option #2

  • Providers, please visit the health plan's website or Fax Request to: 1-954-858-3438

  • Providers call 1-800-470-2004  ext 2501
  • Providers office needs to fax request to: 1-866-341-0408.
    Only faxed nominations will be accepted.
  • Providers Call: 1-630-737-7412
  • Panel Closed for Mental Health Providers
    
    Non Mental Health Providers call 1-800-470-6352 and ask to be transferred to Provider Relations.
    Provider may be asked their County to assist in directing them to the appropriate contractor.
  • Panel Closed for Mental Health Providers
    Non Mental Health Providers please visit the health plan website.
  • Providers, please visit the health plan's website or Fax Request to: 1-866-290-0904
  • Panel Closed for Mental Health Providers
    Non Mental Health Providers call: 1-800-833-7423, Option #2
  • Panel Closed for Mental Health Providers
    Non Mental Health Providers call: 1-800-755-5242
  • Panel Closed for Mental Health Providers
    Non Mental Health Providers call: 1-402-995-7167 or 1-800-471-0240 ext. 7167 
  • Provider office needs to fax request to: 1-702-515-3150  ATTN: Provider Relations
    Only faxed nominations will be accepted.
  • Panel Closed for Mental Health Providers
    Non Mental Health Providers office may send request by either: Fax 1-919-337-1888 or Email to: ContractNominations@cvty.com
    
    Only faxed or emailed nominations will be accepted.
  • Non Mental Health Providers call: 1-800-735-2202 if you are in the following counties:
    Ashtabula, Belmont, Columbiana, Harrison, Jefferson, Mahoning & Trumbul
  • Providers office call: 1-405-945-1236
  • Panel Closed for Mental Health Providers.
    
    Non Mental Health Providers call and ask to be transferred to Provider Relations:
    Western PA 1-800-735-2202
    Central PA 1-800-788-5448
    Eastern PA 1-800-788-5448
  • Panel Closed for Mental Health Providers.
    Non Mental Health Providers office may send request by either: Fax 1-919-337-1888 or Email to: ContractNominations@cvty.com
    
    Only faxed or emailed nominations will be accepted.
  • Panel Closed for Mental Health Providers.
    
    Non Mental Health Providers in eastern South Dakota call: 1-800-470-6352 and ask to be transferred to Provider Contracting.
  • Providers call: 1-901-462-2380, Option 3 if you are in the following counties:
    Benton, Carroll, Chester, Crockett, Decatur, Dyer, Fayette, Gibson, Hardeman, Hardin, Haywood, Henderson, Henry, Humphreys, Lake, Lauderdale, Madison, McNairy, Obion, Shelby, Tipton, Wayne, Weakley
    
    All other providers call: 1-800-937-6824
  • Provider office needs to fax request to: 1-866-341-0408.
    Only faxed nominations will be accepted.
  • Mental Health providers call: 1-800-937-6824
    
    Non Mental Health Providers call:
    Richmond area 1-800-424-0077
    Charlottesville area 1-800-975-1213
    Roanoke area 1-800-240-4345
  • Providers office call: 1-888-388-1744
  • Providers office needs to fax request to: 1-866-341-0408.
    Only faxed nominations will be accepted.
  • Acupuncturist
  • Advanced Practice Nurse
  • Ambulatory Surgery Center
  • Anesthesia
  • Assisted Living Centers
  • Audiologist
  • Autism Councilors (need to be BCBA certified)
  • Behavioral Analyst
  • Certified Nurse Midwife
  • Certified Registered Nurse Anesthetists
  • Chiropractor
  • Dentist
  • Dialysis Clinics
  • Dietician
  • Durable Medical Equipment
  • Emergency Room Physician
  • Home Health Care
  • Hospice
  • Hospitalist
  • Hospitals or In-patient Facilities
  • Imaging Facilities / Radiological facilities (MRI, PET Scan, etc)
  • Infusion Care
  • Laboratory
  • Licensed Professional Counselor
  • Marriage and Family Counselors
  • Massage Therapist
  • Mobile Imaging Providers (MRI, PET Scan, etc)
  • Naturopath
  • Nurse Practitioner
  • Occupational Therapist
  • Optometrist
  • Oral and Maxillofacial Surgeons
  • Pathologist
  • Pharmacy
  • Physical Therapist
  • Physician Assistant
  • Physician Clinics
  • Physician Specialties (MD, DO)
  • Podiatry
  • Psychiatrist (MD or DO)
  • Psychologist (PhD)
  • Radiologist
  • Registered Nurse
  • Skilled Nursing Facilities
  • Sleep Centers / Sleep Facilities
  • Social Worker
  • Speech Pathology / Speech Therapist

• *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
• 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. >>