Become a Provider

How to Become a Provider

REQUIREMENTS

Active State Licensure as a Behavioral Health Professional
Active Malpractice Liability Insurance Coverage of $1 million - $3 million.
Signed Ulliance EAP Contract
Completed & Signed Provider Application
Completed & Signed W9 Tax ID Form

*Completed Documents should be sent to Ulliance EAP
Fax: (248) 680-7311
Mail:
900 Tower Drive
Suite 600
Troy, MI 48098

Provider Video

Watch this quick video and learn the benefits of partnering with Ulliance and becoming a provider!

Easy to apply
Quick turn around
Attract new referrals
Simple paperwork
Quick reimbursement
And more!

PROVIDER FORM FOR CONTACT

If you’re interested in contracting with Ulliance EAP, please complete the short form below. A member of our provider department will get into contact with you about becoming an Affiliated Provider.

Name(Required)

First Last

Email(Required)

Organization Name(Required)

Are you part of a group organization?

Would you be willing to work with First Responders?(Required)

Would you be willing to work with Physicians/Medical Professionals?(Required)

Are you willing to see a client who is mandated for EAP?(Required)

Provider Preference(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Additional Comments

How did you hear about us?(Required)

Benefits of Partnering with Ulliance EAP

1. How do I get paid?
a. - We accept reimbursement paperwork through either fax or email. We send you a 5-page packet per client that we refer to you and we only require a signed consent form and client service record with dates of service marked. Once the case is complete and you bill for the last session, we ask that you complete the ‘final case disposition’ at the bottom of the client service record. Other than that-no progress notes or documentation is necessary!

2. How often do I get paid?
a. Our billing cycle occurs monthly around the 6th of every month. Billing paperwork is processed daily by our client services department. You can also opt for direct deposit through us for even quicker payment.

3. How much does it cost to remain an active provider with you?
a. There is no cost to credential with us or remain an active provider.

4. Do I have to maintain an active caseload to remain active?
a. -Nope! There is no minimum caseload needed to be an active provider.

5. Do I have to see clients in person?
a. No, many of our providers are opting to do services via telehealth only. You can do whatever you are most comfortable with.

6. What if I need to put a hold on referrals?
a. No problem! You can contact our provide team via email/phone and give updates.

7. What if I can’t accept a case?
a. No worries, you can either contact our clinical department or refer the client back to us for a new referral.

Partner with the Ulliance EAP!

Partnering with Ulliance is an easy way to get new referrals, no need to market yourself to get new clients.