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.


The contract collateral and other supporting contract documents should be e-mailed to contract@iehp.org.


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


Providers must also successfully enroll in the state’s Medi-Cal Program to be issued a Medi-Cal number.

Contracting Requirements – New Contract

  • Physician Network Form
  • Medi-Cal Number (Physicians and Medical Groups should be enrolled in the State's Medi-Cal Program)

Contracting Requirements – Existing Contract (Adding New Provider)

  • Medi-Cal Number
  • Physician and Specialists Form (M.D., D.O., D.P.M., D.C., O.D., S.P., AuD., P.T., etc)
  • Mid-Level Practitioners Form (P.A., N.P., and C.N.M.)
  • Supervisor Agreement Form (Only applies to Physician Assistants)
  • Pre-Contractual Letter Form (Only applies to PCPs. Please review and return signed if all outlined criteria is met)

Additional Resources:


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