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Nominate a Provider

If your doctor isn't currently in the provider network for TRS-ActiveCare health plans, you can request they're added to the network by filling out this form.

Please keep in mind:

  • Your recommendation doesn’t guarantee the provider will be accepted into the network.
  • It may take up to 90 days for the provider to be accepted into the network.
  • Providers must meet all established credentialing requirements.
  • Providers must agree to all contractual provisions, policies and procedures.

An asterisk (*) indicates a required field.

Recommend a Provider Form

Specialty type (select):*


1- Please enter a valid phone number