Non-Contracted Provider Resources
PHP (HMO SNP) requires a current W‑9 form to be on file in order to process claims. The W‑9 form is used to verify a provider’s mailing and remittance address.
Claims received from providers that do not have a W‑9 form on file will be administratively denied as non‑clean claims. Providers are required to respond promptly to PHP’s request for a valid W‑9 form in order to receive payment.
Non‑contracted providers must submit a completed W‑9 form with their initial claim submission to ensure timely claims processing and payment.
Providers may submit their W‑9 form using one of the following methods:
PDM Department Email: [email protected]
Fax: 888‑971‑4418 (Please fax the W‑9 form only. Do not include paper claims.)
All payments, including checks, claims remittance advices (ERAs), and IRS Form 1099s, will be mailed to the address listed on the W‑9 form, as applicable.
Providers must submit an updated W‑9 when changes occur, including but not limited to:
- Mailing address
- Legal business name
- Ownership
- Tax Identification Number (TIN)
- IRS form publication updates
If you have any questions, please contact Provider Relations:
- Phone: (888) 726-5411
- Email: [email protected]
- Hours: Monday – Friday, 8:30 a.m. – 5:30 p.m. (closed weekends and holidays)
If you are interested in contracting with the PHP please visit the Join Our Network page to get started.