MHN   Log In
clear clear clear clear clear

Network Participation Request Form

The first step in the proces of joining the MHN network is to enter your Recruiter Code if you have been given one and select the applicable type(s) of practice.

Required Information
* Recruiter Code I do have a recruiter code
* Recruiter code:
I do not have a recruiter code.
*Type of Practice:
(Select all that apply)
I'm a solo practitioner billing under an individual tax id number.
        *Individual Tax ID:
Note: Please verify that the tax ID is accurate before submitting.
I'm a practitioner operating under a fictitious business name or sharing a tax ID with other practitioners or facilities.
*Fictitious Business Name:
*Fictitious Business Tax ID:         Note: Please verify that the tax ID is accurate before submitting.
 

Log In

Network providers log in here.
User Name:
Password:
Forgot user name?
Forgot password?
Need to register?

Join Our Network!
Submit Claims
PIN Look-up