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Join Our Provider Network

Provider Recruitment

Join Our Health Partners Plans Network

Thank you for your interest in joining Health Partners Plans' provider network.

If you are submitting this form as a Medicaid provider, you must have a valid PA Medicaid PROMISe ID.

If you are submitting this form as a Medicare provider, you must have a valid Federal Medicare number and not be listed on the Medicare Opt-Out report.

Please be aware that this form is an inquiry for consideration and not an official registration. We will review your request and if we are in need of your specialty, a representative will contact you to help guide you through our formal application process.

Thank you again for your interest in Health Partners Plans!

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Attestation Statement and Authorization to Release Information

I hereby apply to become a

practitioner in the Health Partners Plans network. (Please check one or both.)

I certify that all of the information that I have submitted in connection with the application is true, accurate and complete. I understand that Health Partners Plans will rely on this information to evaluate my participation in the program(s) provided through Health Partners Plans.

I understand and agree that I am to adhere to and abide by the terms and conditions of this program(s) and any and all Agreements I have or will in the future enter into with Health Partners Plans.

I understand that any material misstatement or omission of fact on the application is grounds for action by Health Partners Plans, including but not limited to summary dismissal from Health Partners Plans as provided in the Provider Agreement.

I attest to having in the amounts required by the State of Pennsylvania current, valid malpractice insurance coverage and all other applicable professional insurances.

I agree to adhere to the code of ethics of the

(AMA, AOA or other appropriate professional organization of specialty or scope of practice).

I authorize Health Partners Plans and/or its designated credentialing agent to consult with members of the medical staff, affiliate hospitals, professional liability carriers, and healthcare facilities with which I have been associated. In addition, this authorization includes consultation with other healthcare professionals who may have information bearing on my competency, character, physical health status, emotional health status, and ethical aspects of my professional practice.

I authorize release of such information to Health Partners Plans and/or its designated credentialing agent upon request. I agree a facsimile or photocopy of my signature will serve the same as the original.

I attest that I have clinical admitting privileges at the Health Partners Plans participating hospital noted on my CAQH or PA Standard application.

I agree to release all Medical Assistance records pertaining to sanctions and/or settlements to HPP and the Pennsylvania Department of Human Services.

I agree to attend at least 1 HPP sponsored provider education training session annually.



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