Provider Certification: New and Renewal Applications for All Provider Types
Please click on the link below if you wish to apply to become a provider, are renewing a provider certification, or to add new service levels or to update demographics to an existing certification. The online application will provide all certification applicants with a secure pin. The secure pin will allow applicants to access the application at any time before it is complete and submitted.
Apply Online to Become A Provider
The guidance documents are found below. New and existing applicants should print the guidance document first to assist them in preparing for the online application process. The guidance document informs applicants what information is necessary and helps to better understand the documentation and certification requirements.
Substance Abuse Treatment Certification Application Guidance (PDF)
Substance Abuse Treatment Certification Application Guidance (word)
Renewal application for state certified providers are electronically submitted through the electronic application portal link above. Please note that the renewal is on an annual basis and must adhere to approved requirements. Additional documents will assist in the process. Each non funded, non accredited provider submit a program evaluation which is an internal quality assurance process that documents all clinical records are complete, signed off, have measureable goals, objective and treatment plans follow and adhere to the goals, etc.
NOTE: The system will send an automated renewal application notice to each provider at least thirty (30) days prior to the current expiration date.
Timeline for completion of the online application process:
Please note: Online applicants, for both new and current providers, have 90 days to finalize the online application process; after that timeline expires the system will purge the application. If purging occurs, there is no way to access this information and any applicant with purged information must begin the application process over.
Please contact Mary Jane Schultz at 1-800-535-4006 or via email at email@example.com for information.