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
MCP Ancillary Facility Network Provider Application (PDF)
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

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.

Screening and Enrollment

Thinking of joining the IEHP Network as a Provider? The requirement to enroll in the Medi-Cal Program applies to all IEHP Providers. Make sure to enroll as a participating Provider in the Medi-Cal program today!

Provider Contract Forms

Thank you for your interest in joining the IEHP network. Get access to contracting forms needed and make sure to submit all documentation.

Provider Network Expansion Fund (NEF)

The Provider Network Expansion Fund Program (NEF) helps support the hiring of Providers that will serve the Medi-Cal population of the Inland Empire. Apply to the NEF Program to be considered for funding opportunities.

Provider Services Phone	909-890-2054
	1-866-223-IEHP (4347)
Provider Services Email	ProviderServices@iehp.org

ICF/DD Providers

Resources:

Screening and Enrollment

Provider Contract Forms

Provider Network Expansion Fund (NEF)

Still have questions?