Complete Our Enrollment Form

Mississippi Health Partners (MHP) Services for Employers and Payors

MHP partners with local, regional and national employers; third party administrators and insurance companies to provide the network of choice for Central Mississippi. Payor benefits provided by MHP include: PHO Contract Administration, Practitioner credentialing, Claims Repricing services, Provider Relations and education, and administrative support.

The form below is for new employer groups enrolling in Mississippi Health Partners network. Providers interested in enrolling as a participating provider need to contact MHP at 601-355-7034 or 800-748-1879.

Group Information

Please attach a sample ID Card, benefit plan summary and utilization management program with requirements.
Please upload jpg, pdf or docx files, limit 5mb each


Effective Date (required)

Group Name (required)

Subsidiaries

Group Number (required)

Number of Employees

Plan Year

Address

City/State/Zip

Phone

Website

Employer Contact Person

Phone

Contact Email (required)

Claims Administrator

TPA (required)

TPA Contact Person (required)

Phone

Address

City/State/Zip

Claims Address (required)

City/State/Zip (required)

Claims and Eligibility Phone (required)

Website

Precertification Company

Phone