Services - American Health Group
 
 

Provider Application
If your are a provider and would like to be in American Health Group's (AHG's) provider network, please follow the instructions outlined below.


 
 
Provider Application

To receive a participation packet and application choose from these options:

  • Complete the form at the bottom of this page with all information requested and click submit. A representative of AHG's Managed Care Department will follow upwith you within two business days.
  • Click here to obtain a printable copy of this page and return the completed form to us by either mail or fax.
    Mail to:
    American Health Group
    Attn. Managed Care Department
    P.O. Box 1500
    Maumee, OH 43537
    Fax to: 419.891.1280
  • If you have any questions, please call our Customer Service Department at 419.891.1212 or Contact AHG by email.
 
 
 
 
Nominate a Provider


  • If you are an employee and your doctor is not a member of one of American Health Group's networks, you can nominate your doctor to join us.
  • Determine if the provider or other medical professional already participates in AHG's Managed Care Network of approved providers. Click here to complete a search.
  • If the doctor is not in AHG's Managed Care Network, Click here to obtain a provider form. Print a copy of this form and take it to your doctor to complete. Once your doctor has completed the form, he may mail or fax the form to AHG.
  • AHG will follow up with your doctor to discuss joining our network and gather any additional information we need.
 
 

Providers: Please fill out the information below and click Submit

Office Contact Name:

Provider's First Name:

Provider's Last Name:

Office Address:

City:

State:

Zip:

Degree (MD, DO, etc.) :

Specialty:

Providers Tax ID:

Reply to me via:      Phone        Email
Phone:

Email:

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