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Interest Form

Interest Form

Let’s talk about how you can help us transform healthcare in Ohio

Thank you for your interest in OhioHealth's Clinically Integrated Network (CIN). The OhioHealth Clinically Integrated Network is a collective of providers, hospitals, facilities and payers working together to transform healthcare. Together, these collaborators impact patients through high-quality, low-cost and coordinated care. By joining the CIN you will be automatically enrolled in the following insurance payors; Aetna, Cigna, Devoted Health, Humana, Medical Mutual, and OhioHealthy. Once this form is received, we will be in touch within one business week.

*Please note this form is to join the OhioHealth Clinically Integrated Network. If you are interested in a contract with OhioHealthy insurance only, please call (888) 841-5670.

Is there a Physician and/or Psychologist/Psychiatrist employed with your group?
Is the practice accepting new patients?
Are all Providers in your group enrolled in and accept Medicare?
Please choose if your group has an established TAX ID number or if you are in the process of obtaining your TAX ID.
Your preferred method of contact: