Dear Prospective Provider,
We wish to thank you for taking an interest in becoming an affiliate provider for Cameron and Associate's, Inc. (CAI). As a nationwide provider of Employee Assistance and Managed Behavioral Health Care services, our Provider Relations Department is always recruiting highly skilled mental health and substance abuse treatment professionals for our network.
CAI welcomes all qualified applicants who meet credentialing guidelines to join our team. It is the goal of the CAI Provider Relations Department to help ensure that all of CAI's clients receive the highest level of care. You, the Provider, play an essential role in this process!
Please download the appropriate forms below and review our guidelines. Do not hesitate to contact a Provider Relations Representative with any questions.
Provider Relations Representative
(800) 334-6014 x 113
Letter of Agreement (LOA)
The Letter of Agreement is a temporary contract for providing services to CAI clients in your community. Please be advised that reimbursement of rendered services requires prior authorization.
The formal application should be submitted within 90 days of signing this Letter of Agreement. This agreement will remain active for six (6) months until the completion of your formal application. To expedite your agreement, please download the appropriate form below, complete, and fax to 404-459-7147.
Click one of the two PDF icons below to download/print the Individual/Group Provider and/or Facility form:
Facility Letter Of Agreement [1.51Mb]
Letter Of Agreement [843.87K]
Individual and/or Group Provider Application
This application allows you to serve as a network affiliate. Please remember to submit all of the requested supporting information/documentation. If you have any questions, feel free to contact CAI's Provider Relations Department. We look forward to a successful working relationship.
Click one of the PDF icons below to download/print the appropriate CAI Affiliate Provider Application: Individual Affiliate Application [157.72K]
Group Affliate Application [152.58K]
Additional Forms
Click each of the PDF icons below to download/print the additional required forms:
Ten Year Liability History Form [279.86K]
MSN Verification Form [96.29K]
Provider Or Practioner Satisfaction Survey [60.66K]
All providers are required to complete CAI clinical forms and submit them to the claims department within 90 days from the date of service for processing.
Please note: In order to be reimbursed for rendered services prior- authorization is required of all network affiliates.
In order for EAP claims to be processed, the following form must be completed and submitted to CAI.
Client Information Form [36.1K]
In order to request authorization for additional sessions for both EAP and PPO members please submit a Outpatient Treatment Form (OTR) to CAI.
Outpatient Treatment Plan Form [216.23K]
Upon initial assessment the member should be given CAI's Notice of Privacy Policies Brochure and the Satisfaction Survey.
Notice Of Privacy Policies [43.69K]
Client Satisfaction Survey [16.13K]
* Claims must be submitted on a HCFA 1500 claim form.
* Please contact our Managed Care department with questions or concerns at, 800-334-6014.
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