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  • Forms
    Payor/Employer Forms
    Payor/TPA Implementation

    For payors, TPAs or self-funded employers interested in contracting with IPN, please complete the form below and return to IPN. An IPN representative will contact you within forty-eight (48) hours of receipt to discuss contracting options. IPN requires a Mutual Nondisclosure and Confidentiality Agreement to release any proprietary information.              

    Provider Nomination

    IPN works to ensure that patients have access to an extensive network of qualified healthcare providers. To nominate a provider who is not in our network, please complete the form below and return to IPN. The recruitment effort, contracting and credentialing process may take up to ninety (90) days. IPN will provide regular updates on the recruitment efforts to clients requesting recruitment.