Provider Information Updates
PHP (HMO SNP) is dedicated to maintaining accurate and up-to-date provider information. Updating your information is easy! Simply complete the online Provider Information form with all current information at the link below. Any changes to billing/remit addresses will also require a new W-9 to be submitted. Please submit W-9 documents to our PDM team at [email protected].
All of the provider information update forms are also available below as downloadable PDFs that can be completed offline:
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.