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We need to know your providers and panel requirements. We plot the timeline and gaps. Reply in one business day.
An un-paneled provider either declines their insured patients or bills them OON with heavy discounts. The therapy happens; the bill doesn’t get paid until credentialing gets completed.
A partial or expired CAQH application stops the review for all payers who use it. A missed 120 days re-attest period can stop the credentialing process in its tracks.
Behavioral health panels close or reach their maximum more frequently than general medical panels, especially in the overcrowded urban areas. A submission to such a panel will stay there undealt with.
The Medicare revalidation cycle and commercial re-credentialing cycles are long. One missed means deactivation of your ability to bill and an uncredentialed provider out of the blue.
Credentialing of mental health providers refers to the process of checking the validity of the credentials of a provider in terms of licensure, education, and qualifications so they get approved. This is the stage before billing.
The term gets thrown around a lot. There are four processes and they cannot be substituted for one another. A provider may be credentialed but unable to bill since there was no activation of the enrollment process. If you know which stage you need to address, you’ll know whom to contact and what to do.
Enrolling the insurance panels involves having a completed CAQH profile, applying to every individual payer, having the payer access your profile, and seeing the process through to completion via committee review.
It is at this step that behavioral practices encounter the greatest difficulties because the insurance environment is fragmented into commercial insurance plans, governmental plans, and managed behavioral plans. Each plan maintains its own enrollment process, and the behavioral enrollment process is generally handled by a separate administrator than the one indicated for the medical card.
BCBS, Aetna, Cigna, UnitedHealthcare, Optum, and regional carriers.
Medicare, Medicaid (CMS), and Tricare enrollment and re-validations.
Managing specialized mental health administrators like Beacon, Magellan, and Carelon.
The credentialing process for behavioral health includes all types of providers, all having unique licenses, board certifications, and payor considerations. A prescriber profile is not the same as a counselor profile.
The key to getting your provider credential application correct is matching the right credentials to the right provider and panel rules. Here are the credential types for which we can enroll.
Layer one is a free document audit. We find the gaps that would stall your applications before they cost you weeks.
Mental health credentialing consists of CAQH account creation and re-attestation, PECOS Medicare enrollment, NPI/NPPES, primary source verification, license/DEA verification and re-validation monitoring.
The above list is not inclusive of all the activities done in managing credentials. It is simply the list of items that we have compiled together in order to update and keep your file active.
Building a profile and the mandatory re-attestation every 120 days
Type 1 (individual) and type 2 (organization) registration
Verified against the issuing authority
COI certificate up-to-date and on file
Address and accepting-patient status current
Part B enrollment and reassignment to the practice
Direct verification from boards and schools
For prescribers (psychiatrists, PMHNPs)
Appropriate behavioral taxonomy mapped to each payer
Deadlines for cycle noted and completed timely
Two attestation cycles: CAQH must be re-attested every 120 days or else it becomes inactive, terminating the attestation process; Medicare re-attestations must take place through PECOS every 5 years and non-compliance will terminate their billing capability.
Yes, because the process of bundling these tasks is more secure. One team handling the credentialing and billing process removes the vulnerability of an approved provider being unable to generate claims successfully.
Revenue is lost at the seam between the credentialing and billing process. The provider is paneled; however, the billing team is missing information on the effective date, the panel ID, and the guidelines of that payer. As a result, the first claims filed are incorrect or delayed. With one team managing the two processes, the billing process knows when the provider is activated and what the payer expects. The approval translates to successful claims.
There will be only one entry of data, too. The credentials, identification, and payer-specific settings collected by the credentialing process will flow directly into the billing process without entering the information twice or creating potential mistakes by transcribing it from one system to another. Practices in search of mental health billing and credentialing services try to avoid such a seam.
Having your work history, documentation, and attestation up to date means that the review process begins immediately without having to make corrections.
Filing all of your targets simultaneously as opposed to sequentially reduces the number of months it takes because you have to wait for each subsequent one to be completed before starting the next.
This involves making sure the payer receives the application and checking the status of the application during the process.
The assessment maps which panels are open, which need exceptions, and how fast each can move. No obligation, no contract.
The credentialing service is typically billed on a per-provider-per-payer basis or in a percentage of collections billing scheme. Certain organizations bill between 4 and 6 percent of collections for their efforts.
Some determinants determine whether a particular practice pays a certain price or another.
RCM Xpert credentialing is performed in all 50 states across the United States from our New York location. The filing procedure is different depending on various factors such as licensing entities, Medicaid programs, and panels’ capacity in each particular state.
Credentialing specific to the state includes verifying the license at the state licensing entity, administering Medicaid program by state managed care organizations, and panels’ different capacity in different markets. The list below includes only states for which there is a page already, and others will be published soon.
Even more states coming up soon
Practice in another state not listed above? We credential in that state as well! Mention your state on the assessment form and we will verify your board and payers.
Mental Health Credentialing usually takes 60 to 120 days depending on the payer, state and completeness of CAQH profile. Commercial payers may take 60 to 90 days while some Medicaid and Blue Cross plans take longer than that. Complete CAQH profile and parallel applications are the factors that reduce the time.
Credentialing refers to the verification of the qualifications of a provider. Enrolling refers to activating the billing process with a certain payer after the credentialing process is completed. Paneling refers to being in the network of the payer as an in-network provider while privilege refers to the right to practice in a facility.
Make sure to have a current attested CAQH ProView record, and apply to each insurance company while allowing them access to your CAQH information. Follow up through the committee review process. If behavioral panel applications are closed, ask for an exception based on network gap and not through a blind application process.
Yes. We credential LCSWs, LPCs, LMFTs, licensed counselors, clinical psychologists, psychiatrists, PMHNPs, and BCBA providers. Each professional has their own set of qualifications and payer requirements. Starting in 2024 Medicare will enroll LPCs and LMFTs directly.
Yes, Optum Behavioral Health, Carelon, and Magellan are managed behavioral health companies that are separate entities from the medical plans and must be credentialed separately from the medical plans they administer. They are panels that close much more frequently than medical plans. We submit our credentialing application with CAQH data and a network need when the panel is closed.
CAQH ProView is the national, free database for entering your credentials once and authorizing insurance companies to retrieve them from there. CAQH is required by most commercial insurance companies and many Medicaid plans but not by Medicare because Medicare uses PECOS. You have to re-attest your CAQH profile every 120 days or it will become inactive.
Pricing is done either by provider per payer application basis or through a percentage of collections. In some cases, companies list 4% to 6% of collections for billing and credentialing combined. The exact price depends on the number of providers, panels, and inclusion of Medicare and Medicaid enrollment services.
Yes. Medicare Enrollment through PECOS, with revalidation needed after 5 years to maintain the billing privileges. State Medicaid enrollment varies depending on the state, but it is generally managed by the Managed Care Organizations.
Yes. One group covering both credentialing and billing fills the gap that exists in the situation where a new provider has been approved but is unable to bill effectively since the billing group knows all about the panel, effective date, and payer policy.
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