Human Behavior Associates

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PROVIDER APPLICATION

The requirements to serve on the EAP referral panel are:

  1. Applicants for EAP or Managed Behavioral Healthcare panels are required to hold state licensure or national certification as a marriage and family therapist, substance abuse counselor, clinical social worker, psychiatrist, professional counselor or psychologist. You must be oriented toward cognitive behavioral, brief problem solving forms of therapy, full use of community resources and follow-up with your patients. A minimum of four years clinical experience and $1,000,000 professional liability insurance policy is requested. Direct experience and certification in Employee Assistance, substance abuse, EMDR, Critical Incident Stress Management or other closely related field should be confirmed with a copy of your certification.
  2. Applicants for Substance Abuse Professional must be licensed as a clinical social worker, psychologist or physician or certified as an addictions counselor through the national (CADC) or international (ICRC) or as an Employee Assistance Professional (CEAP) credentialing program. In addition, you must have completed the required class and certification as a Substance Abuse Professional.
  3. Applicants for the Managed Behavioral Healthcare Panel must hold state license or national certification as a marriage and family therapist, professional counselor, clinical social worker, psychologist or physician (board eligible in psychiatry). You must have a minimum of four years clinical experience and a minimum of $1,000,000 professional liability insurance policy.
  4. HBA also contracts with inpatient, partial hospital, day treatment, residential and structured outpatient treatment programs for psychiatric and substance abuse treatment. Programs must hold appropriate licenses and insurance and be credentialed by JCAHO, CARF or other appropriate boards, if available.

Download Provider Application Checklist

Download Provider Application Form

Download Provider Agreement

Download IRS W-9 Form


 

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