This form is to be completed by independent providers who have privileges at and INTEGRIS Hospital and are wanting to join the IHP network. If the provider does not have privileges at a INTEGRIS Hospital, they need to complete the Participation Request Form. This form is also for providers who are currently part of the IHP network that would like to update information on a current location and/or provider, add a location to an existing IHP provider or close a location where services are no longer rendered.
Please return this form to the INTEGRIS Credentialing Office at [email protected].
This is the first step in the credentialing process for independent providers who do not have hospital privileges. These applicants will be asked to complete the attached INTEGRIS Health Partners Participation Request Form. This form includes key questions for our committee co-chairs to review and decide whether the potential applicant will be granted an application for credentialing. Once the applicant’s participation request form is approved, the applicant will be eligible to receive the full credentialing application and continue through the normal credentialing process.
Please return this form to the INTEGRIS Credentialing Office at [email protected].
Download Participation Request Form
