How to Get Credentialed with Insurance Companies: A Business Owner’s Guide

One of the main hurdles in a behavioral health business’s revenue cycle is promptly getting paid or reimbursed for your services. Most behavioral health service providers prefer becoming credentialed with a widely preferred insurance company as it brings the added benefit of attracting more clients by attaining excellence. Therefore, this blog is essential for you as it tells you how to get credentialed with insurance companies.

Do you want your business to benefit from getting credentialed with insurance companies? Get Strategique Partners’ expert advice from here.

What is the Credentialing of Behavioral Health Businesses with Insurance Companies?

Credentialing a behavioral health business means that a trusted insurance provider evaluates and authenticates your practice by assessing you on necessary standards. When your business is credentialed, you get on the panel of service providers that that insurance company endorses. This way the reimbursements are quick and you get an opportunity to be selected by patients trusting the insurance network as you are one of the in-network providers. 

 

Importance of Credentialing for Behavioral Health Service Providers

Credentialing is particularly important for behavioral health service providers as clients in the healthcare sector often prefer those providers who are paneled on their insurance policy. The following reasons provide the rationale for getting credentialed:

1. Increase in patient access as through their insurance coverage, they can afford your services. 
2. Enhanced revenue flow as reimbursement time decreases.
3. Builds credibility for your practice

Credentialing Process with Insurance Companies

The process is complicated and time-consuming. You should anticipate the following:

1. Elaborate Requirements
2. Lengthy Application Reviews
3. Choosing the Right Insurance Network
4. Preparing with Site and Licensing Audits

The process of getting credentialed requires full-time attention and great preparation. So that you may focus on your business, Strategique Partners offers complete billing services.

Application for Credentialing with Insurance Network

You are required to first select the most suitable and relevant insurance policy to get credentialed with. Then, you begin the process by applying. Most insurance companies use CAQH ProView to obtain your information. Therefore, you should have your profile registered. To avoid delays and rejections, you should fill your application with accurate data carefully. 

Credentialing Phase

After the application phase, you move into the credentialing phase. This comprises of the following:

1. Verification of information by the insurance company
2. Evaluation of the documents provided
3. Confirmation whether you meet the requirements to be a member of the network

The credentialing phase varies for different insurance companies or government policies like Medicaid/Medicare. However, the processes and requirements are essentially similar. 

Contracting Phase

The next phase in your company’s credentialing journey is contracting. You get to enter into an agreement or a contract whereby you can claim reimbursements and be enlisted on their panel of service providers. This entering into the practitioner agreement marks the completion of your credentialing process. Contracting with an insurance network improves your behavioral health business’s revenue cycle. 

Requirements of Credentialing of a Behavioral Health Practice

Before venturing into the credentialing process, you are required to prepare some requirements in the form of documents and state registrations. The success of your application for credentialing depends on the following requirements:

Service Providers Licenses

You need to make sure that you are duly licensed for the services you provide. In case you are already licensed, you should ensure your license is still valid and current. Further, you can get help from our licensing or regulatory services. 

Tax Identification Number (TIN)

It is a requirement to have a tax ID. You get an authorized tax identification number when you register your business as any of the business structures like LLC or S-Corp. 

National Provider Identifier (NPI)

You need to obtain a National Provider Identifier (NPI) number. NPI can be of two types:

1. Type 1: Individual Provider
2. Type 2: Organizational 

This unique number is used in billing. 

Liability Insurance

Healthcare insurance companies require you to be insured for liabilities and malpractices. So having a liability or malpractice insurance policy is generally a requirement of credentialing. 

Ways to Get Credentialed for Behavioral Health Business

Getting credentialed ensures a stable flow of revenue and patients but the process of getting credentialed can be many months long. Therefore, you need to think before doing it yourself without expert guidance. Only take up the task when you know the process and you can dedicate your energies for a few months. We will enlist the options you have in this regard:

1. Do it Yourself Through the Council for Affordable Quality Healthcare (CAQH)

If you think you can be patient enough, applying for credentialing yourself can be a viable option. This business owner’s guide can prove beneficial in that case. Things to consider when you decide to proceed with it yourself:

1. Application to each insurance network needs many hours of dedicated effort.
2. You will need to collect and put together documents like licensure, proof of insurance, TIN, CAQH profile, etc.
3. There are benefits of saving costs and getting trained for future applications. 

2. Hiring an Insurance, Billing, or Credentialing Expert like Strategique Partners

The other option that you can easily resort to is outsourcing this task to a behavioral health business credentialing expert like Strategique Partners. It is a beneficial choice for the following reasons:

1. Strategique Partners is experienced and knows all the requirements of credentialing with various insurance companies and government agencies.
2. It can negotiate fee schedules with insurance companies better than someone having limited knowledge and experience. 
3. We offer you a guaranteed smoother and swifter credentialing process.
4. The approval rates are higher.

Make the credentialing process easier and quicker with Strategique Partners today!

Commonly Asked Questions Regarding Credentialing of Behavioral Health Businesses

We enlist a few of the most asked questions by business owners regarding behavioral health business credentialing in the following lines:

How Long Does It Take To Get Credentialed With Insurance Companies?

The credentialing process generally takes a long while. You may have to wait 3 to 8 months to get credentialed for your behavioral health business. Therefore, it is advised to start the credentialing process fairly early. 

Can I See Patients While Waiting for Credentialing Approval?

Yes, it is possible to entertain clients and provide services without credentialing approval. You can get paid directly from clients. However, you can only see clients depending on insurance billing once you are credentialed with their insurance policy.

What Type of Liability Insurance Is Needed for Credentialing?

Liability insurance needed by credentialing companies varies by minimum coverage amount. However, it is usually general and professional liability coverage.

Are There Unique Credentialing Requirements for Drug Rehab Centers?

Credentialing requirements for drug rehab are slightly more comprehensive. You often require additional licensing and certifications. This makes the process of credentialing a drug rehab center with an insurance company more extensive than other behavioral health businesses.