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Recredentialing Form

As a contracted member of InterGroup Services PPO network, we must periodically update our credentialing information we have on file for you.


To be recredentialed by InterGroup Services, download the recredentialing form from the link above and complete the 3-page form.  We will also accept a PA standard application or a CAQH form if these are already complete and up to date.


We also require a copy of the following:


1. Malpractice insurance face sheet

2. Board Certification


If you received a letter with regard to recredentialing, you were assigned a recredentialing ID. Please have this ID listed at the top right corner of the recredentialing form that you submit.




Please submit the forms to InterGroup Services by either:




Fax: 610-695-2531


If you have any questions, please contact our provider relations department at 800-537-9389.


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