Delegated Provider Participation and Enrollment Process

For delegated provider groups, we have created a streamlined process for submitting provider updates. Delegated entities are only required to submit one comprehensive roster to capture the following:

Enrollments – New providers being added to the existing contract
Demographic updates – Changes to provider information such as name, address, or specialty.
Terminations - Provider ending participation with the delegated group.

Please ensure that all provider changes (adds, updates, and terms) are reflected on your delegated roster submission.

Delegated Provider Roster Template (Excel | .xlsx)

Upload Delegated Roster *

First Name: *

Last Name: *

Contact Email: *

Contact Phone Number: *

Attestation * I hereby certify the above information to be true and correct to the best of my knowledge.

Providers must give Meridian Health Plan notice of voluntary termination following the terms of their participation agreement. Meridian Health Plan must notify affected enrollees covered under the terminating agreement at least 30 calendar days prior to the effective date for any termination. For more information, please review our provider manual.

Please attest to the following: * I understand that in order to provide 30-day prior notice to affected members my effective date of voluntary termination must be at least 30 calendar days from notification.

Last Updated: 08/19/2025