Group with agency credentialed providers

In order to apply for Agency credentialing, your group must be designated as a Community Mental Health Center (CMHC), Federally Qualified Health Center (FQHC), Rural Health Center (RHC), Opioid Treatment Program (OTP), and/or other Federally or State licensed or certified entity (license or certification is at the organizational level).

Your organization must have the minimum Liability insurance of $1 million/ $3 Million for both General Liability and Professional Liability.

If you meet these requirements, click here to complete the Agency application.

For questions or help – contact Network Management at (877) 614-0484

If your Agency only provides ABA services, click here to complete the Autism/ABA/BCBA application.

Please note that the following documents will be required (as applicable):

• A current state license or certificate for all services and locations where you offer services
• Optum accepts the below accreditations. If you are not accredited, a site audit will be required before the credentialing process will be complete
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • Accreditation Commission for Health Care, Inc. (ACHC)
  • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • Community Health Accreditation Program (CHAP)
  • Center for Improvement in Healthcare Quality (CIHQ)
  • Det Norske Veritas National Integrated Accreditation for Healthcare Organizations (DNV NIAHO)
  • Healthcare Facilities Accreditation Program (HFAP)
  •  Joint Commission (TJC)
  • Council on Accreditation (COA)
• Medicaid and/or Medicare certification letters with applicable registration numbers
• Current Professional and General Liability insurance certificates showing limits, policy number(s) and expiration date(s)
• W9 form
• Current Staff roster including license, taxonomy and NPI
• For Opioid Treatment Programs (OTP), copies of the prescribers’ DEA licenses are required

Improve the Speed of Processing - Tips for Applying to the Network

• It is important to attach all correct and required documents as applicable
• If not accredited, a site audit will need to be scheduled and conducted
• Please include a signed completed W-9 form
• Please include a Current Liability Insurance Certificate (will not accept expired)

For help with this process, you can go to Network Management, then click on “Network Management Contact Information” in the network management area.