eApply New Account Request

If you are a provider undergoing recredentialing, you should already have received your account information.  If you have not received that email, please contact an administrator at eapply-admin to have your credentials resent.

If your organization has recently hired a new provider who needs to undergo initial credentialing with Cenevia, please complete the form below.  An account will be created and sent to the email listed under “Credentialing Contact Email” within one business day.

If you have any questions, please reach out to a systems administrator at eapply-admin.

eApply New Account Form

• Organization*
• Practitioner Name*

  
  First
  
  
  
  Last
  
  
  
  Title
  
  

• Practitioner Email*
• Will Cenevia be performing enrollment services for this practitioner?
  • Medical enrollment
  • Dental enrollment
  • Behavioral enrollment
  • No enrollment requested
• Credentialing Contact

  
  First
  
  

  
  Last
  
  

• Credentialing Contact Email