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:

• A copy of the CAQH Standard Authorization, Release and Consent Form with your written signature
• An updated copy of your CV or résumé
• A copy of your master’s or doctoral degree or diploma
• 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.
• 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.

Medicare Credentialing: Medicare credentialing is completed electronically through PECOS, so providers no longer need to submit signed Medicare 855 forms. If you are eligible for Medicare credentialing, you will receive an email from CMS asking you to approve our application request. Our credentialing team will email you once the CMS request has been submitted.

Please note that missing information or delayed documents may postpone credentialing and your anticipated start date.

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

Please provide preliminary information about yourself.

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 and Oasis, including both practices’ information on the Practice Locations tab in CAQH.

If you do not remember your login information, you may reset it through CAQH before completing this form. Please note that we also require a copy of the CAQH Standard Authorization, Release and Consent Form with your written signature.

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), as applicable
• Provisionally Licensed Providers: CareFirst and Cigna

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.

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.

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.