GEHA members, providers or office personnel may use this form to nominate a physician or hospital to the GEHA provider network. Complete the information below and select Submit to send this form electronically to GEHA.
All fields are required unless marked as optional.
If you have any questions, please contact GEHA's Customer Service department at (800) 821-6136. Please complete all the blanks on this form. This information helps us process your request. The nomination process may take three to six months. Not all providers who are nominated will become participating providers in the GEHA provider network.