Member Management Forms
All PMP’s have the right to state the number of members they are willing to accept into their practice. The panel size for members is based on the panel size requested on the Provider Enrollment form. Member assignment is based on the member’s choice and the IHCP auto-assignment process; therefore, MHS does not guarantee any PMP will receive a set number of members.
PMP’s shall not refuse to treat MHS members on his or her panel as long as the panel limit has not been met. MHS must be notified 45 calendar days in advance of a PMP’s inability to accept additional covered enrollees under MHS agreements. To make a change to your panel size, please contact you Provider Partnership Associate.
Member Disenrollment
Panel Management Form
MHS follows a state-defined process which requires MHS approval before a member can be dismissed from a PMP’s panel. Please complete the Member Disenrollment form below in its entirety to request a member be removed from your panel. It can take 30 - 45 days for this removal to occur. For a list of valid reasons for a request for member disenrollment and other important information, please review the Provider Manual.
If your panel is full or has been placed on hold and you would like to add a member, please use the Panel Management Form below. There is no limit on the number or frequency of additions. For additional information about when a member can change their PMP selection and other important information, please review the Provider Manual.