Employee Assistance Program

Credentialing Process

MYgroup requires current credentials for all providers. You are expected to maintain current records with our network staff.

Credentialing

All MYG Providers are required to initially submit the following information:

Provider Application

– Business Associate Agreement (to be signed and returned upon receipt)
– Liability Insurance (form including expiration dates and coverage)
– Licensures (documentation including expiration and license type/#)
W9 Tax ID Form (for payment processing)

Provider Handbook

Provider Handbook Key Points (Review, initial, sign, and return)

To protect the privacy of the client as well as yourself, please do not email any form with personal health information (PHI) unless it is encrypted and password protected according to HIPAA compliance standards.

Updating

Please mail or fax the following documentation upon notification of licensure and/or liability renewal:

– Liability Insurance (form including expiration dates and coverage)
– Licensures (documentation including expiration and license type/#)
– Credentials for additonal EAP providers (for those in a group practice providing EAP services)

Mail all credentialing information to MYgroup, Attn: Provider Management, 5925 Carnegie Blvd., Suite 350, Charlotte, NC 28209. Or, fax all information to 704-529-5917. Attn: Provider Management.

* Note: EAP providers must be 5 years post-grad and fully-licensed to provide services. Non-adherence to this policy will result in cancellation of the Business Associate Agreement. Rare exceptions are made by the MYG EAP Clinic Director on a case-by-case basis due to emergency situations and continued client care.

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