Provider Nomination Form
To nominate a provider for the Alliance contracted provider panel, fill out the Provider Nomination Form below, and fax it to 512.346.9321 (or e-mail to providerrelations@pswca.org). A nomination will not necessarily guarantee the provider will be contracted with the Alliance. We will review the existing provider panel to determine whether additional providers are needed in that particular service area.
Political Subdivision Workers' Compensation Alliance Provider Nomination Form (PDF)
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