The
Group Member Enrollment application instructions describe the steps in this enrollment process. Please read the instructions and complete the following forms to apply to be an IHCP Group Member Provider.
Group Member Provider Specialty list This list will help you determine which specialty to use on your application. This form is informational only and does not need to be submitted with your application
W-9 Form tax identification - Last updated April, 2002
Before you send your application, read the
Enrollment Application Checklist to ensure you avoid the most common mistakes made when submitting provider enrollment applications.
Thank you for your application! You will receive notification by mail when your application has been processed.
