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Request Participation within our Network

Thank you for your interest in participating with Health Net Health Plan of Oregon. We are excited that you have selected our provider network as your network of choice.  Please select the Network Participation Request Form listed below based on your specialty and services you provide. Please return this completed form, along with your W9, to our email address: NewProviderRequestBox@TrilliumCHP.com (Please note: these forms do not replace the credentialing forms/ requirements for our contractual agreements and requirements)

Network Participation Request Forms:

All Medical Specialties except Behavioral Health/Substance use, and except requests managed by “External Contractors” Physician Network Participation Request Form (PDF)

  • Solo Practitioners
  • Allied health professionals such as:
    • Midwife
    • Dietitian, Nutritionist
    • Physician Assistant
  • Medical Groups 
  • Multi-Specialty Medical Groups

Ancillary Network Participation Request Forms:

All Ancillary & Medical Facilities except requests managed by “External Contractors” see next section: Ancillary Network Participation Request Form (PDF)
 
  • Ambulatory surgery centers (ASCs)
  • Dialysis facilities
  • Durable medical equipment (DME)
  • Home health
  • Home Infusion
  • Hospice
  • Laboratory
  • Long term acute care (LCTA)
  • Orthotics and prosthetics (O&P)
  • Ostomy and medical supplies
  • Radiology/MRI/PET
  • Skilled nursing facilities (SNF)
  • Sleep study centers

Network Requests Managed by External Contractors:

  • Behavioral Health:
    Unless an employer group utilizes another behavioral plan, MHN manages behavioral health and substance abuse benefits for Health Net members.
  • Physical Therapy, Speech Therapy and Occupational Therapy:
    Contact Northwest Rehab Alliance (NWRA) at 1-800-219-8835 or email at nwra@taipt.com or visit the NWRA website
  • Alternative Care Specialties such as Chiropractic, Naturopathic, Acupuncture- (Statewide)
    Contact ASH Network (American Specialty Healthcare) at 1-800-678-9133 or visit the ASH Network website 
  • Retail Pharmacies: 
    Contact CVS Caremark® at 480-314-8457
  • Vision Providers: 
    Contact EyeMed Vision Care online at the EyeMed website or 1-866-392-6058
  • Dental Providers: 
    Contact Dental Benefit Providers (DBP) 1-877-410-0176

Network Participation Next Steps:

Once you have completed a Network Participation form, please email all of the documents to the email address listed above.  Someone from our contracting department will review your request for network addition/participation.  A representative will be in contact with you with regarding status of this review. (Please note: If you receive a contract, there will be additional credentialing documents required to finish the contracting process, see next sections.)

Credentialing Requirements/Forms for Contracted Practitioners:

*Action Required: If your practitioners are registered with CAQH, documents noted above are required to be uploaded in CAQH and current. Please authorize Centene Corp to access applications in CAQH.

Credentialing Requirements/Forms for Contracted Facilities

In order to complete enrollment, the following is required for facility credentialing:

How Health Net Can Help you

Let us help you keep your practice in tip-top shape. Use the provider portal for the following:

  • Create multiple user accounts for your staff members.
  • Control permission settings for each staff member's account.
  • Keep track of payments.
  • Convenient 24/7 access to the forms you need most.