Medical Network - Services

Application to Participate in MedNet's Network

New MedNet Applicants should choose their provider type below to access the required forms 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 on March 1, 2009, MedNet became a member of HCAS and switched to 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. It is critical that, once you register with CAQH, you keep your information updated and regularly sign off on the Release and Attestation sections.

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

Please direct all MedNet Credentialing questions to Carole Belliveau, MedNet Credentialing Department at 207-773-5116, ext. 108 or cbelliveau@mainemednet.com.

Please choose your provider type from one of the groups listed below:

	Physician Chiropractor Psychologist Mid-Level Mental Health Provider	Nurse Practitioner Nurse Midwife	Physical Therapist Occupational Therapist Speech & Language Therapist Audiologist Registered Dietician Acupuncturist

	Download and complete the following documents: Terms of Agreement HCAS Provider Enrollment Form W-9 Form Note: 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. 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? Please mail completed documents to: Credentialing Department, Medical Network, Inc., P.O. Box 15253, Portland, ME 04112 Download and complete the following documents: Terms of Agreement HCAS Provider Enrollment Form W-9 Form Addendum for Nurse Practitioners Note: 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. 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? Please mail completed documents to: Credentialing Department, Medical Network, Inc., P.O. Box 15253, Portland, ME 04112 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 Please mail completed documents to: Credentialing Department, Medical Network, Inc., P.O. Box 15253, Portland, ME 04112

Administrative Guides

View/Print the MedNet or UnitedHealthcare Preferred Provider Manual.

	MedNet Preferred Provider Manual
	UnitedHealthcare Administrative Guide

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