Nationally recognized quality standards require us to re-credential our providers every three years. This also helps MHC maintain current information on every provider in our PPO network so that we can match our patients with the provider that will best suit their needs.
Please take a few minutes to complete our online Provider Re-Credential Form. Prior to doing so, please have the following forms ready for upload (in PDF Format): Professional Liability Insurance Coverage face sheet, your current State License(s) (and DEA Registration, if applicable), current W9 Form, current CV/Resume (if changed), and copies of any Certifications you earned in the past two years (optional). MHC will not accept your online Re-Credentialing submission without them. If you’d prefer, you may print a Re-Credential Form, complete it, and submit it to MHC via mail, fax, or email (firstname.lastname@example.org), along with all of the required documents. Our fax number is 215-343-8983. Please do not print the the forms you’ve completed online.
If you are completing our online form, and are contracted with MHC under more than one organization, please print this Additional Organization Information Form (1 form per additional organization) and upload it along with your other required documents.
Please notify us of changes in your address, tax identification number, telephone/fax number, etcetera, as they occur. By doing so, you make it possible for MHC to have the most up-to-date information about you and your practice when as we refer patients to you for counseling.
If you have any questions, please feel free to contact us. Thank you.
1501 Lower State Road
Building D, Suite 200
North Wales, PA 19454