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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 NOTE, IEHP is only accepting Vision Providers who meet the following exceptions through October 31, 2022:

  • Providers practicing in any of the CalAIM service area expansion territories effective January 1, 2022 (including formerly voluntary and excluded zip codes)
  • Providers filling positions that have been vacated in an existing practice
  • Providers transitioning from an existing group agreement to their own individual agreement
  • Providers being added to existing Vision groups

 

Please completely fill out all required documents and submit to jointhenetwork@iehp.org.

 

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

 

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.