Provider Status Online Application

REQUIREMENTS FOR THE ORGANIZATION

  1. Education eligible for PCB approval must be relevant to the field of behavioral health or community health.
  2. Education must use a formal structure.
  3. Education must occur in Pennsylvania unless the organization is an online education provider.
  4. Each training must be submitted using the Education Approval Form. Note: there are two Education Approval Forms depending on the type of training you are submitting – in person or online.

PROVIDER STATUS AGREEMENT TERMS & CONDITIONS

  1. The agreement period is one-year.
  2. Trainings cannot carryover into another year if they are not used.
  3. A predetermined, non-refundable fee is set by PCB for review of trainings.  The fee is paid at the beginning of the agreement.
  4. Upon review and approval of the agreement, the organization will receive an assigned PCB Provider Status number which will be used and referred to throughout the one-year agreement period.
  5. The organization must establish one contact person who will correspond with PCB. This will be the only person whom PCB will provide information to regarding training approval and is the only person who should submit training approval applications to PCB. 
  6. Prior to the end of the agreement year, information on renewing your Provider Status will be sent to the contact person.
Organization Information
This is the person who will be PCB's primary point of contact.
I agree to adhere to PCB’s requirements, terms and conditions for Provider Status. Failure to do so could result in cancellation of Provider Status with PCB or the denial of education hours submitted for PCB approval. This agreement is effective for one-year from date of processing and receipt of payment. I understand the contact person above is the only person who is to submit education approval to PCB.
If you need additional trainings approved, the cost is $75/training until the end of the agreement year.
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