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Provider Recruitment Form

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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