INITIAL CREDENTIALING

Please contact the Provider Relations or Credentialing Departments to request your credentialing materials.    A list of the initial credentialing requirements are supplied for you below.

American Behavioral

M E M O R A N D U M

TO: Professionals Applying for Privileges with American Behavioral

FROM: Allen S. Blackwell

SUBJECT: Credentialing Requirements

Thank you for considering membership in the American Behavioral network of providers. American Behavioral subscribes to the URAC standards for credentialing. Therefore, an extensive amount of work is performed by American Behavioral during the credentialing process.

Please complete the attached Provider Application. Additionally, the following items should accompany your application to American Behavioral offices for credentialing:

          ___ Curriculum Vitae (Please provide month and year from training to current date. If you have gaps in training and/or work history greater than six months, please provide written documentation explaining gap)

___ Current license to practice

___ Current narcotics license, if appropriate

___ Certification of current malpractice insurance thresholds

___ Two letters of reference

___ Academic Diploma (s)

Page eight (8) of the Provider Application is very important and must be signed and dated. Should you not have any malpractice claims experience, initial box at top left corner of page, then sign and date your signature.

Please complete and return within thirty (30) days of receipt. Should any additional information be needed regarding these requirements, please let me know. We look forward to working with you.