PCP and Specialists

Thank you for your initial interest in becoming an Inland Empire Health Plan (IEHP) directly contracted provider. Prior to extending a contract, we must receive the following documents. 

Please completely fill out all required documents.

Any delay in receiving the below stated documents will affect the effective date of the contract that will be mailed to you.

    New Contract          
    Existing Contract
(Adding New Provider)
All documents should be e-mailed to contract@iehp.org                                                                                                  All documents should be e-mailed to contract@iehp.org                                                                                                 
    
  • Individual W-9 and Participation Request forms can be found here