3/9/2010

Are you a Provider? Yes No Current BHP-Contracted Providers Provider Changes/Updates. You are required to notify BHP in writing prior to making any changes to your practice information. Your participation agreement with BHP is specific to the original contracted location or tax id # affiliated with that practice. BHP reserves right to contract with you at a different location. BHP makes site change requests based on geographic location, specialty information, and current business demands. The MN Uniform Practitioner Change Form is a request only and must be approved by the BHP Membership Committee. You will be notified by BHP in writing, once approved. Until you receive the BHP confirmation, you will be unable to receive authorizations or reimbursement for any services at the new site. For changes to your provider membership or provider information including termination from the BHP network or changes to provider sites, license, name, practice, or tax id, complete the Minnesota Uniform Practitioner Change Form. All site change requests must include the following: MN Uniform Practitioner Change Forms, a copy of the current medical malpractice insurance affiliated with the new site, and current W-9 form. Mail or fax to: Behavioral Healthcare Providers Network Services Department 1405 N Lilac Drive, Suite 151 Golden Valley, MN 55422 Fax: 763-797-9882 Network Services Questions For questions regarding your BHP contract, contact Michelle Vidmar at 763-486-4426 or E-Mail For questions regarding your UCare ID number: Phone - UCare Provider Services 612-676-3660 Fax - UCare Provider Services 612-884-2072 E-mail - Click Here Joining the BHP Network Steps to Becoming a BHP Provider Step 1: Review membership criteria & credentialing policies Step 2: If you meet the criteria, complete the MN Uniform Application and supplemental forms Step 3: Submit all forms to BHP Mail completed forms to: Behavioral Healthcare Providers Network Services Department 1405 N Lilac Drive, Suite 151 Golden Valley, MN 55422 *Please do not fax applications Step 4: We will notify you only if we will be proceeding with your credentialing. If we are not able to contract with you at this time, we will keep your application on file for 6 months. We will contact you only if our business needs change during that time. Click on the link below to view/print the Memebership Criteria and Credentialing Policies Application and Instructions Your credentialing application should be submitted correctly and completely in order to process without delays. BHP cannot accept your application if there is missing information. Once your application has been approved by BHP's Membership Committee, it is sent to Fairview System Credentialing Office (FSCO) for primary source verification of credentialing information. We request that you promptly respond to any request received from FSCO on behalf of BHP in order to expedite the credentialing process. Click on the link below to view/print the credentialing application, it includes: - BHP Cover Letter. It explains the credentialing process - MN Uniform Application - Application Tips. Guidelines to ensure your that your application is completed correctly - BHP Survey. Additional information to be used by BHP when weighing membership criteria Credentialing FAQ's Common questions and answers regarding BHP credentialing process. Billing Questions For questions regarding BHP's billing procedures, please click "Billing" on the main menu UCare billing questions Contact UCare Provider Relations at 612-676-3300 or 1-888-531-1493

2002 Behavioral Health Care Providers