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  • Forms

    Credentialing Applications

    To credential a new practitioner or organizational provider, complete the appropriate application below and return to IPN, along with all required documents specified in the Credentialing Matrix and the credentialing fee(s) listed in your IPN Agreement.

    Each provider and organization NPI is required to be credentialed. The credentialing process may take up to ninety (90) business days for completion. Notification will be provided once a credentialing decision has been made. 

    If you do not have an active IPN Agreement, Contact IPN.

    Adds, Changes and Terms

    To add a currently credentialed or hospital based provider to an existing group, to update provider demographic information for existing providers or to remove a provider from your group, please complete the Provider Information form. IPN reports demographic changes to our payors. Payors will update their claim payment system and directory within thirty (30) business days of being notified of such change.

    Supplemental Forms

    Hospital Admit Plan: required in the event a practitioner (MD, DO, NP, CNM, CNS or PA) does not hold active admitting privileges at an IPN participating hospital.

    Prescribe Plan: required in the event a practitioner (MD, DO, DPM, NP, CRNA, CNM, CNS or PA) does not hold a DEA certificate in the state for which they provide services.