Provider Nomination Form

Your ClearChain medical plan is open-access and network-free. This means that you have the freedom to choose any provider you wish, without restrictions or limitations from your plan. 

To ensure your provider will participate in ClearChain Health, complete this Provider Nomination Form below. Our member support team will contact your healthcare provider BEFORE your first appointment to educate them on your new plan and ensure they have the necessary information to submit your claims.

If you prefer to mail or email your Provider Nomination Form, download the form here and submit it to:

ClearChain Health
4230 Tuller Rd, Dublin, OH 43017

Email member support at

Check the status of your provider nomination at any time by calling.
phone: 833-733-8478
fax: 614-467-3610

Member Resources


Getting Started with ClearChain Health

Learn the easy steps you’ll take to start using ClearChain Health and how we’ll help you navigate the process.

Nominate Your Provider

Learn why it’s important to nominate your provider to participate, how to do it and our role before your next visit.

Member Support

Learn how we help with balance billing, chronic disease management and hospital admissions.