Join our behavioral health network

We offer two enrollment applications:

1. New Individual Provider

2. New Organizational Provider

To enroll as an organization, your organization must be actively accredited by a recognized accreditation body (CARF, Joint Commission, URAC, COA, DVN, HFAP or NCQA). If a provider meets all the criteria except accreditation, the organizational provider must be able to demonstrate effective quality management and peer review infrastructures by one of the means listed in our credentialing criteria for Behavior Health Facilities.

If you’re not accredited by a recognized accreditation body (see credentialing criteria for Behavior Health Facilities linked above), you must enroll as a new individual provider.

All behavioral health providers must upload a signed Provider Group Participation Agreement to their enrollment application. If the file size is too large to upload (limit 2.5 MB), submit the application without the agreement. Once your inquiry has been created, open the inquiry under "Enrollments and Changes" and add a comment that the agreement file size exceeded the upload limit. Our team will send the agreement to the group via Docusign to review and sign so the enrollment process can continue. 

Do not enter an effective date on page 1 of the agreement. We’ll fill in your effective date when the enrollment process is complete and return the countersigned copy to you.

Before submitting your enrollment application, you should also make sure you:

1. Have your W9 saved to your computer

2. Review our current fee schedule for behavioral health providers

Follow the steps below to complete your enrollment application. Be sure to follow them carefully and check that each step of your application is complete and accurate before moving on.

Missing or inaccurate information will delay your processing time. Applications missing either the agreement, W9 or Medicaid Disclosure Form may be rejected as incomplete.

1. Create an account in prism, using either Google Chrome or Microsoft Edge as your internet browser.

2. Once logged in, click Enrollments & Changes in the main menu.

3. Click either New Individual Provider Enrollment or New Organizational Provider Enrollment (see “Determine which application type is right for you” above). Follow the enrollment instructions. You’ll need to upload your W9 and signed Provider Group Participation Agreement when prompted.

*For new contracts, we require you to complete the Medicaid Disclosure Form. If you don’t complete the form in your prism application, you’ll receive a message in prism requesting that you fill out our Medicaid Disclosure Form PDF. Failure to submit the Medicaid Disclosure Form on your application or by attaching the PDF to your prism request will cause delay in your credentialing. Attach the completed form to your enrollment inquiry in prism within five business days.

Download the Medicaid Disclosure Form

4. Check Yes when asked if you’re requesting a Medicaid agreement, complete our online Medicaid Disclosure Form and check the consent box.

This is required of all our behavioral health providers unless you have a specified reason why you can’t participate.

5. Click Submit.