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Provider Contract Forms

Ready to contract?

Thank you for your interest in becoming an Inland Empire Health Plan directly contracted Provider. Whether you are new to our network, extending your contract, or in the process of being credentialed, we are here to provide the forms and guidance you need.

Learn more about how to join our network

Please Note: IEHP is currently not pursuing new contracts for the following specialties

  • DME
  • Hospice
  • Home Health
  • Specialty Pharmacy
  • Clinical Laboratories
  • QASP Providers
  • Orthotics and Prosthetics
  • Community Supports Providers
  • Enhanced Care Management (ECM) Providers
  • Community Based Adult Services (CBAS) outside of the Inland Empire
  • Eating Disorder Residential Treatment Centers/Facilities
  • Partial Hospitalization Program (PHP)/Intensive Outpatient Program (IOP)
  • Community Supports Providers (with the exception of Recuperative Care and Short-Term Post-Hospitalization Services providers)

What type of care do you provide?

PCP & Specialists

Join as an IEHP Direct contracted PCP or Specialist.

Access Forms

Behavioral Health

Join our Direct Behavioral Health Program.

Access Forms

Vision

Join our Vision Provider Network.

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Ancillary

Join us as an Ancillary contracted Provider.

Access Forms

ICF/DD Providers

Learn about credentialing requirements to join our ICF/DD network.

Access Forms

Looking to extend or modify your contract?