Provider Email Address Collection

Stay Informed of Health Net Updates

To add your email to the distribution list to receive the latest provider emails, newsletters, policy updates, and other important notifications, please complete and submit the form below:

Practice Name *

Contact Name *

Other

Phone Number

Email Address *

Additional Email Address

Preferred Mailing Address *

Physical Address (if different from Mailing Address)

Group NPI

TIN/EIN *

Provider Type * PCP Specialist Behavioral Health

Plans included in your contract (Check all that apply) * Trillium Medicaid Wellcare By Trillium Advantage Medicare Wellcare By Health Net Medicare Health Net Commercial None