MHC
MHC welcomes
your interest in joining our preferred provider network.
To be considered for participation in our network, the following requirements apply:
1.
A
minimum of a Master’s level degree in a behavioral health related field
2.
At least two (2) years of licensed experience
3.
Three (3) years post-graduate experience preferred
4.
Current state license in your state
5.
Proof of malpractice insurance coverage of at least $1 million per incident, $3 million aggregate
6.
Your history of legal issues is considered
If you are interested in being
reviewed for addition to our Provider Network, please:
1.
Complete the online
Provider Network Application (note: you
will need your license and malpractice information);
then
2.
Complete the online
MHC Disclosure Statement;
and
3.
Submit current copies of the following supporting documents after completing the application
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State License(s) (If psychiatrist, must include DEA and CDS licenses)
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Face Sheet of Professional Liability Insurance (include CAT Fund information if applicable)
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Current Professional Curriculum Vitae / Resume
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Completed IRS Form W-9
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When applicable, include Educational Commission for Foreign Medical Graduates Certificate
Supporting documents can be sent to MHC via fax
or e-mail.
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FAX: |
EMAIL: |
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215-343-8983 |
providerrelations@mhconsultants.com |
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After we receive and review your application, we will contact you regarding your request. Please note that by submitting this application, you are agreeing that you are applying to MHC’s Preferred Provider Network with full intentions of accepting future referrals for all MHC patients.
Thank you for your interest in becoming a preferred provider in our organization. If you have any questions feel free to contact our Provider Relations Department at providerrelations@mhconsultants.com. For more information about MHC, please visit our website at www.mhconsultants.com.
Thank you for your interest in joining the MHC Provider Network.