As part of our onboarding process, please complete the New Provider Onboarding Form.

This comprehensive form collects the information needed by our credentialing and scheduling teams. It also helps us understand your clinical specialties, treatment preferences, availability, and scheduling needs so we can complete your provider profile, begin credentialing, build your schedule, and appropriately match you with new clients.

Please complete all sections and submit the requested documents as soon as possible. Prompt completion will help us coordinate a smooth onboarding experience and prevent potential credentialing or start-date delays.

Before beginning the form, please have the following documents ready:

1. TWO (2) signed copies of the Medicare 855i Form Signature Page. Please print and sign both copies, and either:
   1. Mail them to Orchard Mental Health Group, Attn: Juliane Schoenherr, 9707 Key West Avenue, Suite 100, Rockville, MD 20850; or
   2. Drop them off at our Rockville office.
2. A signed copy of the CAQH Standard Authorization, Release and Consent Form
3. An updated copy of your CV or résumé
4. A copy of your master’s or doctoral degree/diploma
5. A written professional bio for your provider profile. Please consider what you would like potential clients to know about you. For guidance, you may review these tips for writing a compelling provider bio.
6. A professional headshot for your provider profile*

Whenever possible, please upload all requested documents directly through the onboarding form. If needed, you may email your signed CAQH Release Form, updated CV or résumé, and diploma to credentialing@orchardmentalhealth.com. Please note that missing information or delayed documents may postpone credentialing and your anticipated start date.

*The practice will reimburse up to $50 for a professional headshot. Services such as Secta AI may be used. To request reimbursement, please email your receipt and selected headshot to hr@orchardmentalhealth.com.

Thank you for your prompt attention and for helping us make your onboarding experience as smooth as possible!

To complete the credentialing process, we will need to update your CAQH profile using the information provided in this form. To make the process as easy as possible, Orchard Mental Health Group will complete these updates on your behalf.

We will use your CAQH username and password to ensure that your profile contains all the information required by our insurance partners to process your credentialing applications. We will not change or remove any existing information. We will only add new entries related to Orchard Mental Health Group. If you do not remember your login information, you may reset it through CAQH before completing this form.

Providers will be credentialed with the following insurance carriers based on their licensure status:

• Independently licensed providers: Aetna, CareFirst, Cigna, Medicare, Medicaid, TRICARE, and UnitedHealthcare (UHC)
• Provisionally licensed providers: Aetna, CareFirst, Cigna, Medicaid, and UnitedHealthcare (UHC)

IMPORTANT:

• Your CAQH profile must include a complete 10-year employment and academic history with no unexplained gaps. If you do not yet have 10 years of employment or academic history, please list your complete history to date.
• Please upload an updated CV or résumé, even if you previously submitted one with your employment application. For credentialing purposes, your current employer must be listed as “OMHG/GBCC/Oasis.”

Missing information, unexplained gaps, or an outdated CV may delay the credentialing process and your anticipated start date.

This form collects information about your clinical specialties, treatment preferences, and availability so we can complete your provider profile, coordinate your schedule, and match you with new clients who are the best fit for your clinical focus and therapeutic approach.

Please provide your anticipated working schedule. Your availability must align with the scheduling requirements outlined in your agreement, including any required number of afternoon or evening hours. This information will help our team build your calendar template and allow our Access Coordinators to begin scheduling new clients.