Submit Your Group
You or an administrator from your office may submit your group to LifeSynch by filling out and providing the form provided below. A group is one or more providers filing under the same tax ID number.
Please note: An individual application is also required for each provider in the group.
Next Step: LifeSynch Reviews Your Information
Your group will be contacted by a LifeSynch representative to confirm receipt of your application and to begin the contracting process. If you don’t receive notification within five business days, you may contact Provider Services at 1-800-890-8288.
