How to Get Credentialed with Insurance Companies Mental Health

, ,
How to Get Credentialed with Insurance Companies Mental Health

Insurance credentialing is one of the most important avenues for growing a mental health treatment center. Once you have crossed this hurdle and become part of an insurance provider network, you can truly begin to expand your reach. Read on to learn how to get credentialed with insurance companies, mental health specifically.

Learn About Insurance Credentialing

As most consumers are aware, when it comes to locating healthcare providers and specialists, the insurance network directory becomes an essential tool. Insurers are careful to cull the candidates that apply to their network in order to select the best fit for their insured. This selection process involves two steps: credentialing and contracting.

The credentialing piece, also called “paneling,” has to do with meeting the insurance company’s requirements. Only after a mental health provider demonstrates the various licensure and compliance requirements are met can a practice be invited to join. The contracting piece involves negotiating a fee schedule that is agreeable to both parties.

Learning how to get credentialed with insurance companies mental health directory is a key to a provider attaining fiscal health. After a major insurer accepts your mental health practice into its network, consumers seeking mental health services can find you. This provides a lucrative channel for growing your practice and your revenue stream. First, though, you have to engage in a sometimes challenging and time consuming credentialing process.

What is the Purpose of Mental Health Credentialing?

Insurance companies offer their customers access to a curated provider network, which is the product they are selling. The insurance companies need the participating providers, and vice versa, so these networks are a win-win for both.

From the insurer’s vantage point, credentialing helps ensure that they are offering qualified mental health providers to their customers. Because paneling is so competitive, the credentialing process can help raise the bar among providers who want to be included. Thus, it protects the consumer by weeding out the unqualified providers, and then rewards the newly contracted providers with access to more clients.

Credentialing Guide for Mental Health Providers

The credentialing process is quite intricate, requiring patience and time. Providers going through this process should expect it to take several months with unforeseen challenges. It is entirely possible for a mental health practice to undertake this challenge on its own. However, keep in mind that credentialing consultants are available to relieve the burden of this cumbersome endeavor.

Here is a handy guide to assist you in the credentialing process:

  1. Gather your documents. The process begins with an application that will require lots of documentation. Be prepared to have these documents on hand:
    Current licensing in the state where the practice is located

  2. Select insurance companies. Consider which insurance companies are most prevalent in your region, are they reputable, their reimbursement rates, and how long approval takes.
  3. Complete applications. You will need to apply separately to each insurance company.
  4. Follow up. Be sure to check back in a week to ensure they received your application, and ask if they need anything else.
  5. Re-apply if rejected. Often an insurance company has too many mental health practitioners and therefore rejects your practice. Be aware that you can reapply at a later date, as these networks do change.

If your application is accepted, then it’s time to begin the contracting phase of the process. This is when you are often able to negotiate the reimbursement rates. Once you have agreed upon a rate and have signed the contract, your practice is then listed on the network.

Insurance Company Credentialing Challenges

When learning how to get credentialed with insurance companies mental health, it is a good idea to be prepared. Here are some of the common challenges you might encounter:

  • Time-consuming. When you begin the application process you will soon realize that it is very time consuming. It takes time to collect all the documents and meet the various requirements, such as COQH and getting a tax identifier. Once you have submitted the application, it takes about six months to hear back.
  • Detailed. Prepare to follow every step exactly as instructed or your application will be denied. Missing documents or errors only set the whole process back, making it take even longer.
  • Competitive. Getting paneled is not a slam-dunk, as these networks are highly competitive. Improve your chances by offering evening or Saturday hours, crisis services, or a special niche area of expertise.

Outsourcing Insurance Company Credentialing to a Consultant

If the credentialing process seems daunting, you might want to look into hiring a credentialing consultant. These are consultants that specialize in credentialing and contracting, so they know how to navigate the terrain.

Credentialing consultants are aware of the common missteps that can trip up the application process and save you a lot of time and frustration. They are also experienced in contract negotiation, netting you a better reimbursement rate that you could get on your own.

The time you save by outsourcing the credentialing process can be used to focus on hiring and refining your program. Also keep in mind these are tax-deductible services as a cost of doing business.

Circa Behavioral Healthcare Solutions Offers Credentialing Support

Circa Behavioral Healthcare Solutions is a consultancy that specializes in assisting mental health and behavioral health providers. Our credentialing experts offer an important resource for mental health providers looking into how to get credentialed with insurance companies. For more information, please reach out today at (888) 458-6619.

/by