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  • Reliant Behavioral Health Provider Form

Get Reliant Behavioral Health Provider Form

All information given on this application is CONFIDENTIAL and will NOT be sold or released to ... Zip: Primary Office Telephone Number: (. ) Primary Office Fax Number: .... In the last three (3) years.

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How to fill out the Reliant Behavioral Health Provider Form online

The Reliant Behavioral Health Provider Form is essential for practitioners seeking recredentialing with Reliant Behavioral Health. Completing this form accurately is crucial for a smooth application process. This guide provides step-by-step instructions to help you fill out the form online effectively.

Follow the steps to complete the Reliant Behavioral Health Provider Form.

  1. Press the ‘Get Form’ button to access the online application form.
  2. Start by entering your practitioner information, including your full legal name, any other names you have used, birth date, NPI number, email address, and social security number. Ensure that all information is accurate and current.
  3. Proceed to the specialty information section. Indicate your principal clinical specialty and if you wish to be designated as a primary care practitioner. Select additional clinical practice specialties as applicable.
  4. In the practice information section, fill out the details of your primary and secondary clinical practices, including departments, addresses, phone numbers, and fax numbers. Make sure to include any credentialing contact information if applicable.
  5. Complete the practice call coverage section by providing the names and specialties of practitioners who will provide coverage for your practice.
  6. Fill out the additional education section. List any residencies, internships, or specialized training completed in the last three years.
  7. Provide details about your healthcare licensure, registrations, and any relevant ID numbers. Ensure to attach copies of required documents such as current licenses and certifications.
  8. Complete the professional practice/work history section chronologically. List your work experience for the last three years, and provide explanations for any gaps longer than two months.
  9. Answer the attestation questions truthfully. If you need to provide details for any 'yes' answers, do so on separate sheets.
  10. Review your entire application for accuracy. Make a copy for your records. Finally, save your changes before submitting the form online.

Complete your Reliant Behavioral Health Provider Form online today to ensure a seamless recredentialing process.

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Questions & Answers

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Yes, you can access your medical records online through the patient portal provided by Reliant Medical Group. By signing in, you can view your health information, schedule appointments, and manage your care efficiently. Using the Reliant Behavioral Health Provider Form can help you understand how to navigate this system more effectively. It's designed to enhance your access to healthcare documentation without unnecessary hassles.

Yes, you can access MyChart Reliant on your phone through its dedicated mobile app or website. This feature allows you to manage your health information, schedule appointments, and communicate with your providers on the go. Utilizing the Reliant Behavioral Health Provider Form can help you keep track of your treatments and access your records seamlessly while using MyChart.

Yes, Optum does own Reliant Medical Group. This relationship allows Reliant to offer a broader range of healthcare services, ensuring you receive quality care. With the Reliant Behavioral Health Provider Form, you can navigate your services more easily, enhancing your overall healthcare experience.

You can request medical records over the phone, but it may depend on the policies of your healthcare provider. Ensure that you have the necessary information ready, such as your identifiers and details of the records needed. The Reliant Behavioral Health Provider Form can be a helpful tool in streamlining this process by documenting your request clearly and efficiently.

The Reliant Medical Group typically uses a standardized email format for communication. Most emails follow the structure of firstname.lastname@reliantmedicalgroup. Ensure that you use this format when reaching out, as it can facilitate your inquiries related to the Reliant Behavioral Health Provider Form or any other services they offer.

Carelon serves as the behavioral health component of Medi-Cal. It provides crucial support for mental health and substance use concerns to those eligible under Medi-Cal. When filling out the Reliant Behavioral Health Provider Form, you can access various services offered through Carelon for comprehensive care.

To become a qualified behavioral health provider, individuals typically must complete relevant educational and training programs in psychology, social work, or counseling. They must also obtain necessary licenses or certifications, which often involve supervised practice. Utilizing the Reliant Behavioral Health Provider Form can help streamline the documentation process required for licensure, making it easier for aspiring providers.

Healthcare providers in behavioral health facilities include psychiatrists, psychologists, social workers, and licensed counselors. These professionals work together to deliver comprehensive mental health care to patients. To verify the qualifications of these providers, a Reliant Behavioral Health Provider Form can help you assess their credentials and specialties.

A command referral is a recommendation made by a healthcare provider to guide patients toward receiving behavioral health services. This referral initiates the process for accessing specialized care and ensures that patients receive the appropriate support. If you require the Reliant Behavioral Health Provider Form to facilitate this process, you can find it conveniently through uslegalforms.

United Behavioral Health operates as a subsidiary of UnitedHealthcare, providing specialized behavioral health services. While they are part of the same parent company, they focus on different aspects of healthcare. If you need the Reliant Behavioral Health Provider Form, it’s essential to contact the specific provider directly to ensure you understand their services and coverage.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232