Insurance credentialing for therapists

If you have questions about mental health credentialing with insurance companies or insurance credentialing for therapists, you’re in the right place.

Many therapists are interested in becoming affiliated with insurance plans in order to provide more accessible and affordable care to a larger number of clients of all income levels.

However, we often don’t receive much guidance as to how to go about becoming a health plan network provider.

This article explains the steps of mental health credentialing with insurance companies so therapists understand how to join an insurance network as a provider.

What is insurance credentialing for therapists?

Mental health credentialing with insurance companies refers to the process of applying to health insurance plans for inclusion in their provider networks.

When a therapist is successfully credentialed with the plan, they are known as a network provider, a participating provider, or a panel provider.

As a paneled provider, they are then able to accept client referrals from the health plan, and the clients may use their insurance coverage to help pay for covered services.

Key steps in the process of insurance credentialing for therapists

Wondering what is the process of credentialing?

For therapists and clinicians focusing on mental health credentialing with insurance companies, there are two phases in the process—credentialing and contracting.

The credentialing phase begins when the therapist completes a credentialing application.

The health plan then performs a thorough credentials verification of the provider, checking all the information on the application, and ensuring the provider meets their credentialing requirements. Then, the file is reviewed by the credentialing committee for approval.

Once approved by the credentialing committee, the second phase, contracting, begins.

Contracting is when the provider is sent a network participation contract. In this phase, the provider reviews the language of the participating provider contract, including the reimbursement rates and all the details and responsibilities of participation. If the provider agrees with the contract, then they will sign the agreement.

Once the agreement is signed and returned to the network, the clinician is given an effective date so that they can begin billing the plan and receiving “in-network” reimbursement for your claims.

What about provider enrollment in Medicare and Medicaid plans?

If you’re wondering about the process of insurance credentialing for therapists with Medicare and Medicaid, these plans are a bit different.

There are forms unique to these plans that you may need to fill out to enroll as a provider.  

Medicare

Medicare is a federal plan for older adults and people with disabilities that has provider enrollment forms which can be complex and time-consuming. Find out more about Medicare enrollment here.

It is strongly recommended that you get help from a Medicare enrollment expert if you choose to fill out this very detailed enrollment application.

Keep in mind that unlike private health plans, if you choose NOT to enroll, and you’d like to see Medicare clients in your practice, you will need to formally opt-out of Medicare by filling out a Medicare Opt Out Affidavit. You would need to send this in to Medicare, then have each Medicare client sign a Medicare Private Pay Agreement (sample here).

Medicaid 

Medicaid plans are state-based, so enrollment rules and forms may vary by state. Contact your state Medicaid plan for more information to learn how to get credentialed with Medicaid.

Therapists are not required to contract with Medicaid, however, they must be contracted with Medicaid to be reimbursed by that plan.

How long does it usually take to be credentialed with a health plan?

The length of time it takes for mental health credentialing with insurance companies to be complete varies widely depending on the health plan.

Keep in mind that it may take as long as 4-6 months, even if you fill out every box on the application and don’t make any mistakes.

The plan is asking for my CAQH number. What’s this, and why do they want it?

It is recommended that therapists wanting to work with insurance plans complete a CAQH profile to speed applications.

CAQH is a national provider data portal where providers can store information about themselves and their practice, previous experience, education, and documents such as their malpractice and license.

Think of it as an online provider file cabinet that has a file on you. Insurance plans may ask for your CAQH file number when you apply to their plan, as this helps them more quickly gather information about you.  However, it does not take the place of an application.

Is mental health credentialing with insurance companies the same for all types of psychotherapists?

Yes, the steps for mental health credentialing with insurance companies are the same for all types of psychotherapists. However, services in the contract may vary.

For example, CPT codes for psychological testing services may be included in a psychologist’s contract when they would not be in a standard contract for a therapist with only a Master’s degree.

All that said, contracts are quite similar between therapists.

What are the best insurance panels for therapists? 

There is no agreed-upon “best” insurance panel for therapists.

If you polled a group of network therapists, many would give one health plan a high rating, while other network providers might give that same plan a poor review.  A therapist might provide a low rating for a particular insurance plan because of a bad personal experience with that health plan.

Or, a low rating for an insurance payer may be provided because the therapist’s records were audited by the plan, a stressful event.

However, the biggest factor contributing to a therapist’s negative review of an insurance payer is likely that the therapist’s reimbursement rate with that plan is low.

Therefore, it is important to remember that a health plan may pay providers in different states (and even in different cities) wildly different reimbursement rates, which can affect provider satisfaction levels.

Other factors that lead to dissatisfaction include poor health plan phone support and fewer client referrals.

Well, then how do therapists know which plans to apply to?

Of course, asking colleagues about their experience with various health plans is a good place to start.

Another strategy is to join a handful of plans and get your own experience working with these plans then you can choose for yourself if you want to resign from some and which ones you want to stick with.

Are there resources for mental health credentialing with insurance companies that could help me?

If you don’t want to do this all by yourself, you have some choices.

To get some assistance with insurance credentialing for therapists, you can:

• Hire a billing service that will do the credentialing for you.
• Hire a credentialing service. Insurance credentialing services for mental health providers are organizations that exist just to help therapists credential with health plans. However, some therapists I have spoken with felt that they did not get their money’s worth with these agencies, or did not feel they had enough control over where applications were filed.

Sources

• Centers for Medicare and Medicaid Services.  Become a Provider or Supplier 
• Centers for Medicare and Medicaid Services,  Manage Your Enrollment.  
• Credentialing Paradise.  Demystifying Insurance Credentialing: A Step-By-Step Guide For Healthcare Providers.  
• Griswold, Barbara. SimplePractice Blog. How to get a raise (in your insurance reimbursement rate)
• National Credentialing Solutions: What is Insurance Credentialing?  
• Noridian Medicare.  Private Pay (Opt Out) Medical Services Contract.

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