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How to Get Credentialed with Insurance Companies for Behavioral Health

Insurance Credentialing for Behavioral Health

Healthcare providers, including behavioral healthcare, are all too aware of the necessity of securing contracting with major insurers. Insurance credentialing is the bread and butter of the fiscal health of any healthcare provider. The process for a behavioral health provider to obtain insurance credentialing can be tedious and frustrating. To learn how to get credentialed with insurance companies, read on.

What is Insurance Credentialing?

Creating a stream of revenue and patients for a mental health or substance recovery center depends almost entirely on insurance billings. To establish a working relationship with an insurance provider or network, a behavioral health practice must complete a credentialing process. This involves establishing procedures for billing third party networks for any services rendered.

Major insurance companies include Aetna, Cigna, Humana, United Healthcare, Blue Cross Blue Shield, Tricare, Medicare, and Medicaid.

Understanding how to get credentialed with insurance companies is a critical first step. The process entails two main components, credentialing and contracting. The credentialing aspect involves meeting certain requirements of the insurance company in order to be accepted into the network, During the contracting step, the terms of the claim reimbursements are negotiated.

Why is Insurance Credentialing Important for Behavioral Health Providers?

Most people rely on their health insurance coverage to pay for a substantial portion of health or behavioral healthcare services. For this reason, insurance credentialing is a critical component for any healthcare provider in creating a reliable revenue stream.

Once your behavioral health practice is vetted and credentialed, you have the ability to bill the various insurance companies. Being included in an insurers in-network provider directory allows your practice to be discovered by a wide range of patients. This exposure to new patients is what helps your behavioral health center grow and prosper.

How to Prepare for Credentialing

Prior to embarking on the insurance credential process you will need to ensure that your ducks are in a row. It’s important to remember that credentialing is all about proving your company’s qualifications in order to be considered for the network. Before you fill out the first piece of paperwork, you will need to have established your practice by pulling together the following:

  • Demographic information about your behavioral healthcare practice or center
  • Provider’s (doctors, therapists, clinicians) CVs, such as education, work history, professional references, and licenses.
  • Obtain a National Provider Identifier (NPI)
  • Obtain a tax identification number
  • Obtain liability and malpractice insurance
  • Complete the CAQH application

How to Get Insurance Credentialing for Behavioral Health

When you begin the actual insurance credential process, you should plan on it taking at least 90 days to complete, and sometimes much longer. It is a time consuming process and requires time and patience as you progress through the following steps:

  1. Submit a letter of interest (LOI). Reach out to the various insurance companies to formally request consideration as an in-network provider by submitting a LOI.
  2. Submit requested documents. After the insurance company has accepted the LOI request, it will assign your practice or center a ticket number. The ticket will detail the specific documents needed to move forward in the credentialing process. These include state licenses and other credentials required to practice behavioral health services.
  3. Contract negotiations. Once the insurer has approved your application and reviewed the required documentation, it is time to begin contract negotiations. This critical step specifies the fee schedule for medical services rendered.
  4. Review final contract. After the contract has been agreed upon, the behavioral healthcare institution signs the payor agreement. This document provides important details, such as the date coverage is effective and agreed upon fee schedules.
  5. If you are rejected by an insurer, you can appeal the decision. If the appeal is denied, plan on reapplying every six months, as in-network providers do fluctuate.

Common Challenges of the Insurance Credentialing Process

While it is possible to sail through the credentialing process, that is the exception more often than the rule. Here are some of the common issues that can pop up:

    • The amount of time required for each insurer that you apply to can be cumbersome.
    • Your application is lost or returned for inaccuracies
    • Constant follow up is required
    • If the process is delayed, your practice is placed on hold

While joining an insurance panel can allow you to grow your practice, it’s important to know that panels have become highly competitive. Some panels are already saturated with behavioral health practitioners and simply aren’t accepting any new providers at a given time.

Help for Credentialing with Insurance Networks

As a behavioral healthcare provider learning how to get credentialed with insurance companies, you may decide to outsource this process. Partnering with a credentialing consultant can help you avoid pitfalls that may otherwise prevent you from operating your center.

A credentialing consultant has the specific expertise needed to navigate the insurance credentialing process successfully. Not only can a professional consultant take the burden of credentialing off your shoulders, but they can also help you negotiate a higher paying fee schedule. Although there is some upfront expense involved for this service, the higher fee rate will offset the expense in the future.

Saurage Collective Connects You with an Insurance Credentialing Specialist

Saurage Collective is a team of credentialing specialists that provide the expertise and resources to assist you in navigating insurance credentialing. If you are seeking information about how to get credentialed with insurance companies, we can help. In addition to credentialing, our team can help you negotiate the most favorable fee schedule contract. Our comprehensive suite of credentialing services can expedite and simplify the process for you. Call us today at (888) 818-3044.

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