Membership Application

These are the requirements to apply to be a member of the IPA:

  1. Download (bottom page), print, complete and sign the attached Membership Application and Participation Agreement.

  2. Print your CAQH data summary and print and sign your CAQH attestation.
    To access this information, sign into CAQH.  Click on the "attest" tab.  Then, click on the "review" button.  These are the 6 pages you will need to print. Then, click on "review complete" at which point "attestation" comes up. Click on "attest". Print the attest form and sign.

  3. Review the attached membership dues information and payment options. Include your check for dues, or follow instructions on the handout to pay by credit card or make payment arrangements with our accountant.

  4. When all the above documents are completed, mail them, with your dues, to the address at the bottom of this form.

Once the membership committee has received and verified all of your documentation, your application for membership in the SWBHIPA will be submitted to the Board for the final approval of membership. Board approvals currently happen once a month. Once approved, a fully executed copy of the Participation Agreement will be returned to you for your records.

Membership Dues

Membership dues are payable at the time of application. The start date of your annual membership in the IPA will begin the month the Board of Directors approves your membership. Membership dues renewal will be each year on the month of your acceptance into the IPA. You will be sent a yearly renewal notice 30 days before your dues expire.

Full member:

Applicants must hold a current professional license for independent practice in behavioral healthcare, issued by an accredited licensing board in the State of New Mexico.

Full member benefits:

  • Full members are included in the contracts the IPA negotiates with Insurance payers
  • Discounts on Continuing Education Workshops presented by the IPA
  • One vote at each annual general membership meeting
  • Networking opportunities

Full member annual dues: $300.00

Associate member:

Associate membership is for behavioral health providers who are working toward an independent, professional behavioral health license in the State of New Mexico, and who are under supervision by a qualified, fully-licensed practitioner. These are clinicians who want to support the IPA, and who wish to receive the networking and educational benefits. Associate members are not eligible to sign IPA contracts.

Associate member benefits:

  • Networking opportunities
  • Discounts on Continuing Education Workshops presented by the IPA

Associate member annual dues: $50.00

Affiliate member annual dues: $80.00

Agency Membership:

This category is for Agency/group practices of 2 or more clinicians who operate under one tax ID#. (Contact us for Agency membership dues information.)

Payment Information: Send your check made out to SWBHIPA to the address below.
To charge your membership by credit card, or arrange for a quarterly payment option, (there are additional fees for this option), contact our accountant, Melissa Padilla at

Pay Membership Dues