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 (PDF)

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 General Materials

IHP Covered Services- Oct 2018 (PDF)

IHP Noncovered Services- May 2019 (PDF)

IHP
Medication Quick List- Nov 2020 (PDF)

IHP Dental Benefit Summary- Jan 2018 (PDF)

IHP Dental Copayment Schedule- Oct 2018 (PDF)

IHP Dental Q&A English- Jan 2018 (PDF)

IHP Dental Q&A Spanish- Jan 2018 (PDF)

IHP Guidebook English & Spanish (PDF)

IHP Urgent Care Centers English & Spanish- June 2019 (PDF)