Forms

EHP makes many of our forms available for your access through our Web site. You can download the files (in Adobe® Acrobat® format) from this page and print the forms for completion. To read these files you must have the Adobe® Acrobat® Reader™ installed on your computer. If you do not have it installed, you may download the program by clicking the icon below.

EHP Provider Information

Credentialing Information

• MD, DO, DMD, DDS, OD, DPM, and DC Credentailing Requirements
• Non-Physiscian Behavioral Health Provider Credentialing Requirements
• Physician Extender/Therapist Data Requirements
• Recredentialing Form
• Provider Application Form*
• Authorization for Release of Information

Policy and Procedure

• EHP Provider Office Manual
• EHP Significa Provider Office Manual
• Payer Listing (claims/benefits/preauthorization information)
• Out of Panel Referral Form

*The PA Standard Application is accessed by permission of the Pennsylvania Medical Society at their website.

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