The Preferred Provider Network Application

 

The Preferred Provider Network (PPN) is a private network of preferred providers who specialize in the treatment of compulsive gambling. Applications, authorization, utilization, reimbursement and monitoring of the quality of the clinical work of the PPN is managed by The Evolution Group, Inc. Funding for these services is provided by the Responsible Gaming Assosociation of New Mexico on a funds available basis.

To become an approved provider in the PPN, applicants must meet all requirements herein and complete the full PPN Application with all required attachments and information submitted.

Approved applicants receive notification along with a provider agreement to sign and return to The Evolution Group, Inc.

Requirements to be a Provider include the following:

  1. Applicant must provide documentation of being certified as a compulsive gambling treatment provider either by the New Mexico Council on      Problem Gambling or the International Gambling Counselor Certification Board, or
  2. Applicant must have completed a minimum of 30 gambling specific treatment CEU’s (documentation of all CEU’s must be attached).
  3. Applicant must be willing to attend a monthly PPN Peer Supervision meeting online.
  4. Applicant must complete PPN Application with all required attachments.
  5. Applicant must provide and maintain a current CAQH profile in good standing which meets the following criteria:
    1. The applicant has provided documentation of being licensed by the State of New Mexico as a Counselor, Social Worker or Psychologist.
    2. The applicant has provided documentation of professional liability insurance at the 1M/3M aggregate.
    3. The applicant has no unresolved licensing complaints or matters before their board regarding their license.

 If you meet all the criteria above, please continue below to complete the application.

Preferred Provider Network Application
Address: *
Address:
City
State/Province
Zip/Postal
Country
Are you licensed in the State of New Mexico? *
Are you currently Gambling Treatment Certified? *
If no, please upload any gambling specific CEU's you might have.
Maximum upload size: 2.1MB
Is your clinical supervisor Gambling Treatment Certified?