Mental & Behavioral Health Provider/Group Credentialing
Client Discovery Form
This form focuses on gathering information on the wound care providers, practice, services offered, location, documentation, and payer details needed to assess Medicare/Medicaid, Medicare Advantage, Medicaid MCO and commercial payers credentialing and enrollment requirements.
• Complete every applicable field. Select only services currently provided or planned.
• Upload supporting documents through the secure upload fields. Do not email protected or sensitive documents.
• Items marked “if applicable” may not apply to every provider or practice. Upload documentation through the secure portal only.
• Submission does not guarantee payer approval, network participation, or reimbursement.
Thank You — Your Discovery Form Has Been Submitted
Your Mental Health & Behavioral Health Credentialing Discovery Form has been received.
Please keep your submission reference for your records. Our credentialing team will review the information and contact you if clarification or additional documentation is required.
Secure document reminder: Do not email sensitive credentialing documents. Use the approved HIPAA-compliant secure upload process.
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