Applications

"Applicant Contacts"

For general information about HCAS, go to www.HCASMA.org

Please direct all MedNet Credentialing questions to Carole Belliveau, MedNet Credentialing Department at 207-289-1040, ext. 108

Please mail completed documents to:

Credentialing Department, Medical Network, Inc. P.O. Box 780 Scarborough, ME 04074

Medical Network is a member of CAQH. After registering with CAQH, it is critical that you keep your information updated, keep all documents current, and regularly sign-off on the Release and Attestation sections.

New MedNet Applicants should locate their provider type and access the list of required forms below to begin the application process. These forms must be completed and mailed to MedNet’s Credentialing Department in order to begin the enrollment process.

Please note that MedNet is a member of HCAS and utilizes CAQH’s Universal Provider Database for our Credentialing and Re-credentialing processes for all doctoral level providers, Nurse Practitioners, Nurse Midwives, and all Mental Health doctoral and Mid-level Providers.

Once you register with CAQH, it is critical that you keep your information updated and regularly sign off on the Release and Attestation sections.

Physician, Nurse Practitioner, or Nurse Midwife

Download and complete the following documents:

Terms of Agreement

HCAS Provider Enrollment Form

W-9 Form

Notes:

You will receive a welcome packet from CAQH with full instructions for registration and application. As soon as this process is completed, MedNet can begin the credentialing process.

Mental health provider applications for United Healthcare do not go through MedNet. To apply for these payers, please contact your third party administrator to get on their plan.

Hospital Admitting Privileges: If you do not have hospital admitting privileges, how and by whom are hospital admissions and inpatient coverage of your patients handled?

Physical Therapist, Occupational Therapist, Speech & Language Therapist, Audiologist, Registered Dietician, Acupuncturist, Chiropractor, Optometrist, Psychologist, or Mid-Level Mental Health Provider

Download and complete the following documents:

Terms of Agreement

HCAS Provider Enrollment Form

W-9 Form

General Release & Attestation

Complete either a Maine Application Form or provide a copy of your CAQH Application.

Note: The Maine Professional Application Form is written in Omniform. It can be either run or saved to your computer so that you can fill it out and email or print it as needed.

Please provide copies of your License and Certificate of Insurance