Behavioral Health providers
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.
To join the Harvard Pilgrim Health Care and Tufts Health Plan networks, complete the following forms
- Ancillary Practitioner Data Form Behavioral Health or an Ancillary Data Form Community Mental Health Center/Substance Use Treatment Center/ABA Services
- W-9
Submit completed materials by email to [email protected].
Please note that a credentialing application must also be submitted at proview.caqh.org. Allow 10-14 days for your request to be processed. If you have questions about becoming a participating provider, please contact the Provider Service Center.