• Wilmington Mental Health
    3825 Market St., Ste 4
    Wilmington, NC 28411
    P 910.777.5575
    F 910.777.5273
    info@wmhwc.com
  • PROVIDER CREDENTIALING

  • Credentialing is the process where insurance companies review applications and verify information about the status of your license, malpractice insurance coverage, education and training using criteria defined to meet accreditation. The credentialing process generally can be completed between 60 to 180 days depending of the insurance company. For you to become an in-network provider, we need you to provide the following information that are asked during credentialing and contracting.

  • License Information

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Certifications

  • Registrations

  •  / /
  •  / /
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Professional Liability Insurance

  •  / /
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Population Served

  • Wilmington Mental Health
    3825 Market St., Ste 4
    Wilmington, NC 28411
    P 910.777.5575
    F 910.777.5273
    info@wmhwc.com
  • Managed Care Networks

  • Wilmington Mental Health works with the following companies and a few others:

  • Sanctions

    If any of the following statement applies to you, please submit a detailed explanation on a separate page.
  • Wilmington Mental Health
    3825 Market St., Ste 4
    Wilmington, NC 28411
    P 910.777.5575
    F 910.777.5273
    info@wmhwc.com
  • ATTESTATION

  • I authorize Wilmington Mental Health, its affiliates, employees, and agents, to obtain information regarding my experience and qualifications I hereby authorize and give my consent to Wilmington Mental Health to release to any entity contracting with Wilmington Mental Health, including manage care networks, EAPs or healthcare organizations, any and all information that may be relevant to Wilmington Mental Health's credentialing or recredentialing process.

    I hereby hold harmless Wilmington Mental Health and any and all entities providing information to Wilmington Mental Health from any liability connected with or arising from the release of such information. Furthermore, I hold harmless Wilmington Mental Health from any liability arising from its evaluation of this application and its credentialing procedures. I further agree that in the event that there are any changes with respect to the information I provided in this application, I shall immediately notify Wilmington Mental Health of such changes.

    I hereby represent and warrant that this application has been completed in good faith and that all information is true, accurate and complete.

    Provider Rights
    • The right to review information obtained during credentialing process subject to applicable laws and excluding any peer review information.
    • The right to request the status of their application at any time. This request may be made by contacting our Office Manager verbally or in writing. Status is defined as one of the following: (a) incomplete application (b) primary source verification, meaning the application information is currently being verified or (c) pending review, meaning the verification of information is completed but the file has not yet been reviewed by the insurance Committee.
    • The right to correct erroneous information obtained during the credentialing or re-credentialing process. The provider must respond, in writing, to Provider Relations (i.e., Insurance Company) within 30 days. The provider must explain the discrepancy, may correct any erroneous information, and may provide any proof that is available.
    • The right to appeal a denial decision. The provider must respond in writing, to Provider Relations within 30 days of the decision date. The provider should include any additional information available.

    The following documentation will be required as part of the credentialing application (as applicable):

    o Professional License
    o Education and Professional Work History
    • Please note: If you have had any gap in employment that was longer than 90 days, please add this information with the month and year (to and from) with brief explanation.
    o Certificates and Diplomas
    o Board certification (optional)
    o Updated Resume or Curriculum Vitae (CV)
    • Must show Wilmington Mental Health as present employer
    o National Provider Identifier (NPI) Number
    o Government-issued picture identification (Driver’s License or Passport)
    o Social Security Number
    o Drug Enforcement Administration Registration Number (DEA)
    o Hospital affiliation
    o Life support training (CPR, ACLS, PALS according to the requested privileges)
    o Proof of Malpractice Coverage

    Please Note: It is your responsibility to ensure that all information reported on this application is factual.

  • Clear
  •  / /
  • Wilmington Mental Health
    3825 Market St., Ste 4
    Wilmington, NC 28411
    P 910.777.5575
    F 910.777.5273
    info@wmhwc.com
  • ACCOUNTS AND LOGINS


  • We will use your CAQH ProView credentials to complete credential applications and enrollments with organizations that require your professional information for claims administration, credentialing, directory services, and more.


  • The National Plan and Provider Enumeration System (NPPES) has been developed by The Centers for Medicare & Medicaid Services (CMS) to improve the efficiency and effectiveness of the electronic transmission of health information.


  • NC Tracks is an Information System for the N.C. Department of Health and Human Services (N.C. DHHS) used to process all Medicaid services and claims.

  • All healthcare providers offering services to Medicaid recipients must be enrolled in NC Tracks. Enrollment in NC Tracks requires a $100 fee upon initial enrollment and then re-enrollment ("reverification" every 3 years.

    Mental Health will pay the enrollment fee up front, and the provider will be expected to reimburse Wilmington Mental Health within the first 90 days of employment. Payment can be in the form of check or money orders. Please make checks payable to: Wilmington Mental Health, PLLC. Wilmington Mental Health will cover the NC Track enrollment fee once a provider has been with the agency 2 years or longer.


  • Wilmington Mental Health has partnered with Google Workspace to offer a HIPAA compliant software to its employees for productivity and collaboration. Your credentials will be mailed to your personal email before you can log in for the first time.

    URL:mail.google.com
    Username: jdoe@wmhwc.com
    Password: Randomlyassigned (can changed after first log in)

  • Wilmington Mental Health
    3825 Market St., Ste 4
    Wilmington, NC 28411
    P 910.777.5575
    F 910.777.5273
    info@wmhwc.com
  • POLICY

  • This policy is to document Wilmington Mental Health's Credentialing and Re-credentialing process.

    It is the policy of Wilmington Mental Health that all Licensed Independent Practitioners (LIP) hired or contracted will be subject to a credentialing process. Individuals will be credentialed at time of initial employment and updated every two years thereafter. In order to promote the highest quality of care, Wilmington Mental Health ensures that all employed and contracted practitioners and providers meet minimum standards relative to licensure, education, and board certification, if applicable. The licensure, educational, and board certification is verified by the collection of specific credentials on a routine basis.

    Medical practitioners requiring credentialing are defined as Medical Doctor (MDs), Nurse Practitioners (NPs) and Physician Assistants (PAs Behavioral Health practitioners requiring credentialing are defined as physicians and psychiatrists (MD or DO); masters or doctorate level psychologist who are state licensed (PhD or PsyD): licensed Advanced Practice Nurse Prescribers (APNP): masters or doctorate level Licensed Clinical Social Workers (LCSW); Licensed Marriage & Family Therapists (LFMT); Licensed Professional Counselors (LPC); and licensed Clinical Substance Abuse Counselors (CSAC) who are certified to practice independently.

    Providers are defined as Behavioral Health outpatient services.

    Credentialing of staff (employed) physicians, behavioral health practitioners:

    1. The credentialing verification activities for these practitioners are performed by Wilmington Mental Health PLLC
    2. Wilmington Menta Health’s requirement for completion of education is based on the practitioner type. Primary verification of highest level of education is outlined by the following provider types:
    a. For MDs, Wilmington Menta Health will verify board certification via the American Board of Medical Specialties (ABMS) online.
    i. For NP, PA-C and other credentialed providers, requirement for practitioner education is based on practitioner type. Primary Source verification is completed by confirmation from the NC Licensing Department. If the healthcare professional is board certified, primary source verification from the appropriate specialty board is completed.
    3. Delegated Credentialing. Wilmington Mental Health may delegate credentialing activities to contracted provider groups. The group must agree to follow Wilmington Mental Health credentialing requirements.
    4. Recredentialing: Wilmington Mental Health requires that all complete the recredentialing process at least once every two years. A verification form will be sent to the provider. All providers are expected to respond to the request in a timely manner. Proof of insurance including the limits must be sent with the verification form. All Providers must be recredentialed and approved for continued network participation.

    Acceptance of Referral

    • Routine/Urgent - When a patient contacts Wilmington Mental Health requesting services through the clinical intake department, a brief screening is completed to review the presenting problems, and evaluate for risk, past psychiatric history, and usage of drugs and/or alcohol. After the assessment, patient is provided with the provider's name, office address, appointment date and time, and is assigned a behavioral health who most closely matches their needs, and for managed care, their presenting issues.
    • Same-Day Referrals - Wilmington Mental Health will contact the provider and offer information about the appointment time and presenting problem.

  •  
  • Should be Empty: