Doctor filling out MetroPlusHealth provider initial application forms on a desk with laptop and paperwork.

Forms for Initial Application – Providers

Getting started as a MetroPlusHealth provider is simple with our easy-to-access Initial Application forms. Whether you’re a physician, specialist, or healthcare facility, we provide the resources you need to join our trusted network. Our step-by-step application process ensures accuracy and efficiency, helping you complete your enrollment quickly so you can focus on delivering quality care to our members.

Doctor filling out MetroPlusHealth Provider Initial Application form at a desk with medical documents and a laptop. Doctor filling out MetroPlusHealth Provider Initial Application form at a desk with medical documents and a laptop.
Start your journey with MetroPlusHealth—complete your Provider Initial Application today.

Initial Application Forms

 W-9 Form W-9 Form
Disclosure of Ownership Attestation Disclosure of Ownership Attestation
DOH OHIP Participating Provider Owner / Manager Certification Form DOH OHIP Participating Provider Owner / Manager Certification Form
Provider’s Confirmation of Exclusion Process Provider’s Confirmation of Exclusion Process
Roster Template - Provider Information Form Roster Template - Provider Information Form
Contracting Information Form Contracting Information Form
Billing Intake Form Billing Intake Form
Collaborative Agreement - Midwifery Attestation Form Collaborative Agreement - Midwifery Attestation Form
PA Supervision Statement PA Supervision Statement
Sample IRS Letter Sample IRS Letter
Sample Annual eMedNY Medicaid Certification Sample Annual eMedNY Medicaid Certification
Collaborative Agreement - NP Attestation Form Collaborative Agreement - NP Attestation Form

Provider Support

 Provider Tools Provider Tools
Provider Resources Provider Resources
Provider Newsletters Provider Newsletters
Authorization Grids Authorization Grids
Transportation Benefit Guide Transportation Benefit Guide
Domestic Violence Domestic Violence
HEDIS / QARR Materials HEDIS / QARR Materials
last updated: August 13, 2025
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