In-Network Provider Account Registration – (Outpatient Only)

**Already participating in-network outpatient providers are authorized to use this registration request form**

Request to join ATAP’s network:

Any out-of-network providers please contact us at 215-677-8820 -or- email 

How this form works:

Please provide us with the information requested below and click submit. We will review your registration request, and you will receive an email notification to let you know if you have been approved. Once approved, you will be able to use our website to request authorizations, request re-authorizations, and check member benefits.

Fields in red are required

Member’s Quick Contact

All fields are required. The members quick contact portal should be utilized for basic questions regarding the Allied Trades Assistance Program's services. If this is a true emergency please contact 800-258-6376