Payor Spec Sheet

This form contains information that we require when contracting with a new payor. Please make sure all blanks are completed accurately. Incomplete information could lead to delays with the payor applying appropriate in-network discounts when processing claims.  

If you have questions or need assistance, contact PHN's Payor Service Coordinator at (920) 272-1100 or 1-866-640-7444.

The form can be downloaded from this web site. For you convenience, a link is provided below.

To view the Payor Spec Sheet, click here.

To view a sample of a PHN  Payor Network Agreement, click here.