When you have completed the forms, please mail them to:
Health Network Services
P.O. Box 6170, Mail Code AX-305
Columbia, SC 29260
Facilities Credentialing Application
Mental Health Practitioners
Provider Credentialing Application – This form is for initial credentialing. You can either key the information in on the computer and print the completed application or print the application off and fill it in by hand. Please note that if you key the information in on the computer, you can save the application and update as necessary.
Provider Recredentialing Application – This form is for recredentialing, an important part of your professional agreement which is necessary to maintain active network status. Our credentialing staff will contact you to let you know when it is time for you to complete this update.