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Get Anthem Provider Application for Temporary Participation

S agency or an individual practice and who will be practicing in Maine for less than a six (6) month period and has a Maine permanent license. If you will be practicing for longer than six (6) months, you should pursue credentialing with our Plan, giving ample time for the completion of that approval process. The attached Provider Application for Temporary Participation and the IRS Form W-9 is necessary for participation in a group or solo practice and must be completed and returned to us in ord.

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