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 / Credentialing Forms

 W-9 Form
Disclosure of Ownership Attestation
DOH OHIP Participating Provider Owner / Manager Certification Form
Provider’s Confirmation of Exclusion Process
Roster Template - Provider Information Form
Contracting Information Form
Billing Intake Form
Collaborative Agreement - Midwifery Attestation Form
PA Supervision Statement
Sample IRS Letter
Sample Annual eMedNY Medicaid Certification
Collaborative Agreement - NP Attestation Form
ADA Attestation Form
Behavioral Health Provider Information Form
List Contracted Ambulatory Surgery Centers
List of Participating Dialysis Center
List of Participating Hospitals
OB/GYN Specialty Subspecialty Form
Provider Hours Form
Provider Information Form (PIF) Spreadsheet
Provider Information Form (PIF)
Mental Health Provider Reimbursement Attestation
Admitting Privileges with MetroPlusHealth Network Facility
Tips for Adding a New Provider to a Participating Group

Provider Support

 Provider Tools
Provider Resources
Provider Newsletters
Authorization Grids
Transportation Benefit Guide
Domestic Violence
HEDIS / QARR Materials
last updated: March 24, 2026
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