ICF/DD Providers

Thank you for becoming a part of the Inland Empire Health Plan (IEHP) Provider network. For initial credentialing, ICF/DD Homes must submit the items and information mentioned below in addittion to the ICF/DD Attestation.


Please send all credentialing collateral and other supporting documents to contract@iehp.org.

Credentialing requirements

  • W-9 Request for Taxpayer Identification Number and Certification
  • Certificates of Insurance (Professional and General Liability)
  • City of County Business License (excludes ICF/DD-H and -N homes with six or less residents)
  • 5% Ownership Disclosure
  • Ancillary Facility Network Provider Application



You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.