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

Speak to a Health Plan Expert.

or give us a call at: 800-475-8466
Friday Health Plans is open Monday - Friday 8am - 5pm MST and will respond within 24 hours.