Provider Application Request

Thank you for your interest in contracting with DMBA. Please complete this online request and we’ll be happy to give consideration to your request for a provider application.

  • Dental providers outside of Utah and Idaho should contact MetLife at 1-800-942-0854 for contracting inquiries.
  • Medical and Mental/Behavioral Health providers outside of Utah and Southeast Idaho should contact United Healthcare Options PPO Network at 1-888-830-0179 for contracting inquiries.

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