Greetings from Friday Health Plans! 

Our Provider Relations team is updating provider information and we need your help. Please complete the below demographic form for your group and include a current roster. Having accurate data will help us serve you better. We appreciate your assistance! 

Supplier Demographic Request

  • The purpose of this document is to ensure demographic accuracy from our Business Partners (Supplier). Instructions: Please answer all questions and submit.
  • General Information

  • Credential Information

  • Contract Information

  • Claims/Billing Information

  • Medical Records Information

  • Upload your current roster

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Friday Health Plans is open Monday – Friday, 8am – 5pm MST.
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