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Thank you for your initial interest in becoming an Inland Empire Health Plan (IEHP) directly contracted provider.

 

PLEASE NOTE, IEHP is currently not accepting new:

  • DME
  • Hospice
  • Specialty Pharmacy
  • Clinical Laboratories
  • Non-Emergent Medical Transportation (NEMT)
  • Community Based Adult Services (CBAS) outside of the Inland Empire

 

Please check monthly for updates on Network Availability.

 

Prior to extending a contract, we must receive the following items listed below. Any delay in receiving the applicable documents will affect the effective date of the contract that will be mailed to you. 

 

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

 

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

Medi-Cal Screening and Enrollment

 

Visit the following page for more information on the Medi-Cal Program.

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Provider Acknowledgement of Receipt (AOR)

 

All Providers must also annually submit the Provider Acknowledgment of Receipt (AOR). IEHP is required by State and Federal regulators to maintain an AOR form on file for our Providers signifying your receipt and review of the Policy & Procedure manuals, including annual updates.

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Contracting Requirements

  • Completed Letter of Interest (LOI) Form
  • W-9 Form
  • Proof of Medi-Cal enrollment or proof of Medi-Cal application submission. Please refer to our Screening and Enrollment page for additional information. 

Contracting Requirement Forms

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.