Join our behavioral health network

We offer two enrollment applications:

• New Individual Provider
• 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, as an organization application would not be appropriate.

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. Agreements that only include the signature page will not be accepted. Additionally, we do not accept agreements that are separated into several attachments.

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 W9 or CHAMPS enrollment (Medicaid) 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.
   Note: To be eligible for Medicaid participation, you must be actively enrolled in CHAMPS.
4. Click Submit.