PROVIDER MATERIALS

Missing materials? Below is a list of items you can access online or reprint as needed.

Provider Specific Materials

IHP Provider Manual- Nov 2017 (PDF)

Provider Registration Form- Oct 2018 (FILLABLE PDF)

Provider Portal Registration Tutorial (Video)

Provider Claims Appeals+ Adjustments Request Form (DOC)

Provider Claim Inquiry Status Form- Oct 2018 (PDF)

Provider EOB Description List- Dec 2020 (PDF)

Member Information Change Request Form- Sept 2020

Prior Authorization Request Form

IHP Behavioral Health Benefit Description 6-18-21

IHP General Materials

IHP Covered Services- August 2021 (PDF)

IHP Noncovered Services- August 2021 (PDF)

IHP
Medication Quick List- Aug 2021 (PDF)

IHP Dental Benefit Summary

IHP Dental Copayment Schedule

IHP Dental Q&A (English)

IHP Dental Q&A (Spanish)

IHP Guidebook (English) June 2021

IHP Guidebook (Spanish) June 2021

IHP Urgent Care Centers (English & Spanish)