Contract Request Form
Thank you for your interest in joining the PA Health and Wellness provider network.
We are excited that you have selected PA Health and Wellness's provider network as your network of choice and look forward to an opportunity to partner in the service of our community.
Please note, at this time, our network is meeting Participant needs for Personal Assistance/Homecare service(s) and not accepting new requests to become a participating provider.
PHW appreciates your interest in joining our team of providers and asks for your understanding in the decision to close the network to new applications. The decision is aimed to match the needs of members with the availability of our providers, ensuring adequate membership volume to support the staffing of our participating groups.
Updates to announce counties accepting applications for PAS service providers are based on member need and can occur at any time. In the event we have a county that would benefit from additional provider choice, we will consider new providers with sufficient existing capacity for those specific counties only.
Counties Accepting PAS Provider Applications (Closed unless listed)
All other specialties are open for application in all counties.
To get started, please complete the form below and someone from our Network Development team will respond back to you within two weeks. An application packet which includes information required for credentialing will be forthcoming.
- PHW Physical Health Contract Initiation Form (PDF)
- Form for LTSS Providers (Home and Community Based Services and Skilled Nursing Facilities) (PDF)
For contracting inquiries reach out to: