Other Forms

Are you interested in joining our network? We welcome new members to our IPA. Here are some additional forms that may be necessary to join. Download, fill out, and fax it back to us at 713-599-0616.

Participating Provider Agreement

TDI Application

W-9 Tax Form

HealthVelocity PLLC, is an Independent Practice Association (IPA) that offers a comprehensive ancillary healthcare delivery system to employer groups, MCO's, participating provider networks and consumers, including:
• Dental Referral Plans
• Provider Networks
• Third Party Administrator Services

HealthVelocity Group, Ltd., provides the third party administrative services for HealthVelocity, PLLC including:
• Network Management
• Utilization review
• Claims Adjustment
• Quality Assurance
• Provider Credentialing
• Business Development and Marketing

Dentists, PLLC is a statewide network of independent dental providers accessible through an arrangement with HealthVelocity PLLC, to deliver dental services including:
• Treatment Delivery
• Peer Review
• Dental Plan Design

Learn more about Health Velocity by visiting our Company Profile.

Other Forms

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