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Become a Contracted Provider
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I have a contract or have started the process of contracting with MHS, and want to add provider(s) to a Group or Facility contract
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Tax ID Number
Individual NPI Number
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Group NPI Number
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Specialty
Contract Type
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Medical
Behavioral Health
Medical & Behavioral Health
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Provider Type
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Sole Proprietor (Practitioner billing under own TIN)
Group Practice
Facility/Ancillary
DME
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Contract Products
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All Products
Hoosier Healthwise
Healthy Indiana Plan (HIP)
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Ambetter from MHS
Allwell from MHS
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Legal Name (W9)
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Contact Title
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Legal Practice Name
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Practice County
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Contact Email
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To enroll a new provider to your existing contract, use the
Existing Contract
form.
