Welcome New Providers!
ACI is always seeking qualified professionals to join our nationwide panel of providers. To apply please review the mandatory requirements below, complete the contract and provider survey below and fax both documents to ACI Provider Relations at 858-452-7819. Upon receipt, an ACI Provider Relations Specialist, will contact you to review ACI's policies and procedures, and to answer any questions.
All ACI providers must:
- Provide evidence of a current state license as MFT, LCSW, or Psychologist. In some states, an alcohol provider or equivalent certificate is acceptable for M.A. level providers.
- Demonstrate experience in working with corporations and/or EAPs.
- Have extensive knowledge of community resources.
- Provide proof of professional liability insurance at $1 million occurrence, $3 million aggregate, or higher.
While working with ACI:
- You will find that there is minimal paperwork involved. From application to billing, ACI values your time and keeps processes streamlined.
- You will experience a flexible referral process. ACI allows clients to self-refer to panelists following the EAP assessment and referral process.
- You will be required to participate in ACI's simplified utilization review and quality assurance systems, including client status surveys.
At ACI, we actively recruit and value bilingual and multilingual providers, as we provide the highest level of service to our diverse clientele.
Membership to ACI's provider panel is contingent upon our receipt of all Provider licensure and insurance documents.
For your convenience, important documents that providers frequently access are located on this site. Please download application, billing and HIPPA forms below and feel free to contact our office at 858-452-1254 if you have any questions.
To view these documents, you need "Acrobat Reader"
(click to download)
Application Documents:
ACI Provider Contract
Provider Survey
Billing Forms:
Client Intake Form
Program Utilization Form
HIPAA Forms:
HIPAA Documents
HIPAA letter to providers
