Get Pif

Filling out the Provider Information Form (PIF) online is a crucial step for individuals seeking to join the Health Net Preferred Provider Network. This guide will walk you through each section and field of the form, ensuring a seamless and effective submission process.

Follow the steps to complete your PIF online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by thoroughly reading the instructions included with the PIF, noting the requirement to attach this fax cover sheet as the first page if submitting via fax.
3. Carefully enter your tax identification number, type I national provider identifier (NPI), and social security number into the appropriate fields.
4. Complete the identifying information fields. Ensure that your last name, first name, date of birth, and other identity details match your CAQH application.
5. Respond to the disqualifying questions genuinely, as a ‘yes’ answer for any may prevent participation.
6. Fill in your practice information, including practice name, address, phone numbers, and relevant specialty details. Ensure accuracy to match CAQH.
7. Provide credentialing point of contact information, including name, mailing address, phone number, and email address.
8. Review the criminal history review and investigative consumer report disclosures thoroughly, ensuring you understand the implications.
9. Complete the credentials attestation, authorization, and release section, ensuring to sign and date the form appropriately.
10. Once all sections are complete and reviewed, you can save your changes. Then, either print the form for physical submission or consider alternative methods for submission based on your needs.

Ready to join the network? Complete your PIF online today!