JOIN THE ADVANTAGE CARE SELECT NETWORK

ADVANTAGE Care Select welcomes your participation in the Care Select Program.  In order to enroll as an ADVANTAGE Care Select Provider please complete the following forms and return all to :

• Care Select Addendum
• Managed Care PMP Enrollment Form
• ADVANTAGE Care Select Provider Demographic Form
• Covering Physician Form
• Attestation and Authorization Form

All forms should be returned to:

ADVANTAGE Health Solutions, Inc.
Attn: Care Select, Katie Tucker
9045 River Road, Suite 200
Indianapolis, IN  46240