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How to submit the request:
Information to include in the request
- Name of Insured
- Address of Insured (including zip code)
- List any specific physicians that should be included in the panel
- Contact person
- If Panel can be sent to electronically, include an e-mail address
- If Panel should be sent hard copy, include mailing address
Timeframe for completing panel submissions
- Up to 10 panel requests will be provided in 24-48 hours of the request
- Between 10 and 40 panel requests will be provided within 5 business days of the request
- Over 40 requests, Operations team will provide an estimated time of completion
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