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.

In addition to your application for MedNet, all Mental Health providers wishing to see United Healthcare patients must apply directly United Behavioral Health using the following web link. https://www.ubhonline.com/cred/credLocations.jsp?state=ME&stateName=Maine

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

As of 04/01/12, for all PT/OT/ SLP and Chiropractors, MedNet is no longer the delegated network for United HealthCare. In addition to your application for MedNet, in order to see UHC patients, these specialists must contact Steven Vynorius at OptumHealth Care Solutions, 603-508-6117 or steven_m_vynorius@optumhealth.com.

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.

Please provide copies of your License and Certificate of Insurance