Provider Access Information
If you are a provider interested in signing up to access CHIP,
please follow the steps listed below:
- Click on the Provider Interest Letter link
below.
(You must have Adobe Acrobat Reader to view).
- Print out the letter and the attached
form.
- After reading the info, an authorized person (such as
doctor, dentist, office manager
or billing supervisor) needs to complete the
form.
- Send or fax back to City of Mesa at the
address/fax number given on the link.
Once we receive the form, upon verification, the authorized
person will receive information on accessing
CHIP. Depending on the volume of requests, please
allow up to five (5) business days to receive the
information.
Provider Interest Letter/Form
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