Becoming a participating provider
Becoming a participating behavioral health provider is simple, and we’re here to help every step of the way! Below you'll find instructions on forms to complete and return. In addition, please note that a credentialing application must also be submitted at proview.caqh.org. If you have questions about becoming a participating provider, please contact [email protected].
Complete following forms
- Ancillary Practitioner Data Form Behavioral Health or a Ancillary Data Form Community Mental Health Center/Substance Use Treatment Center/ABA Services
- W9 Form
Return the completed forms in one of the following ways:
For Harvard Pilgrim Health Care
- Email: [email protected]
- Fax: 1-866-884-3843
For Tufts Health Plan
Email: [email protected]