Provider Information Form (PIF)

The Provider Information Form (PIF) is a supplemental request for information unique to Health Net Federal Services, LLC (HNFS). This form is only for providers who are contracted with HNFS. If you do not already have a contract, please complete the Join Our Network form first. 

We require 30 days to process new PIFs. Please allow for this time frame before contacting us regarding your application status. The full credentialing process may take anywhere from 60 days to 180 days from the time we receive a complete application.

Please use the fax cover sheet included in this PDF as the first page of your fax. Applications that do not have this cover sheet as the first page of the fax will not be processed.

Fax: 1-844-224-0381

Note: Do not use this form to update demographic information. This form is for credentialing purposes only. You may update your demographic information using the Provider Demographic Updates form.

Behavioral health providers should not fill out the PIF. Visit the MHN website and click on Join Our Network for questions about joining the behavioral health network and the MHN credentialing process.

  • Created: Aug 15, 2013
  • Modified: Feb 7, 2018
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Veterans Crisis Support

Support for your patients who are U.S. Veterans:

  • 1-800-273-8255 Press 1
  • Confidential chat at VeteransCrisisLine.net or text to 838255

Because one small act can make a difference.