Network application
The WEA Provider Network includes medical, chiropractic, mental health, medical supply, and dental providers. There are several advantages to joining the WEA Provider Network:
- Claims payments are faster.
- No reasonable and customary (R & C) cutbacks to collect from members.
- Dispute resolution is handled between the provider and the Trust. Members do not need to be involved.
- Provider information is published in the Find a Doctor and Find a Dentist sections of our Web site, and in our provider directories.
* If you are an existing provider who would like to report changes to your profile or practice, please visit Provider updates.
To apply, simply complete and submit a WEA Provider Network Application and W-9 Tax Form, attention Bonnie Ossmann, via fax no. (608) 276-9119 or mail to WEA Trust, P.O. Box 7338, Madison, WI 53707-7338.
Application and Forms
Provider Network Application electronic form – Select this option if you have five or less service locations and 20 or fewer practitioners, and have Microsoft Word. If you don't meet these criteria, please use the .pdf form below. Selecting this option will open a Word form. Electronically enter your information, print and mail with your W-9 Tax Form.
(The tab key will move you between form fields. Press the spacebar to select a check box.)
Provider Network Application (pdf) – Select this option to print the form, enter your information, and mail with your W-9 Tax Form.
W-9 Tax Form (pdf) – Print this form, enter your information and mail with your application. (Sorry, no electronic version is available at this time.)
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Return your application and W-9 tax form by fax or mail.
Attn: Bonnie Ossmann
WEA Trust
P.O. Box 7338
Madison, WI 53707-7338
Fax: (608) 276-9119
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