How to Get Your Mental Health Business Credentialed with Insurance Companies?

The US mental health business market is not only largely running on the indirect payments through insurance reimbursements, but also dependent on insurance paneling for client influx. This is mainly because if you are not credentialed with insurance companies, you are invisible to most clients. However, for mental health businesses, insurance credentialing is observed as one of the toughest tasks, with long waiting periods, loss of revenue, and uncertainty. This is why, through this blog, we break down how to get your mental health clinic credentialed with insurance companies efficiently. 

Now, Strategique Partners helps mental health businesses get credentialed with insurance companies with ease and smoothness!

Understanding Insurance Credentialing in the Behavioral Health Market

Credentialing with an insurance company or provider enrollment is the process of getting approval to bill insurance companies for services provided by your mental health business. Insurance credentialing is key to good revenue cycle management. Insurance companies can be both governmental and private. Some of the common ones in the USA’s mental health market are the following:

1. Medicare/Medicaid, both governmental
2. Aetna
3. Cigna
4. Optum
5. Blue Cross Blue Shield

Once a business gets approved, its clients can use the benefits of the insurance company to pay you indirectly through the insurer. When a business gets credentialed with an insurance company, it becomes an in-network provider. 

Why Getting Credentialed with Insurance Companies is So Important?

Getting your behavioral health business credentialed with insurance companies is a necessity. There are exceptional benefits with regard to credentialing a business with insurance companies, such as:

1. Referral pipelines from other providers open up.
2. You can attract higher-volume clients and diversify your payer mix.
3. Clients can use their insurance instead of paying out of pocket.
4. Your monthly revenue becomes more predictable.

In a market as competitive and complex as that of mental health, being an in-network provider is not optional; it is rather a necessity if you want your mental health business to scale and thrive. 

Stepwise Guide: How to Get a Mental Health Business Credentialed with Insurance Companies

When you start a mental health business, you go through various steps to ensure a systematic startup. Similarly, the credentialing process should also be systematic. We break it down into actionable steps, which are easy and provide a systematic approach. Here is a detailed breakdown:

1. Basic Compliance of Mental Health Business

Mental health business licensing is a must when you go for credentialing. However, in addition to that, there are numerous other basic requirements. These include the following:

1. A legal business entity (LLC, PLLC, or Corporation)
2. An Employer Identification Number (EIN)
3. An NPI (both individual and organizational, if applicable)
4. Active malpractice insurance and crisis management for mental health businesses

You can get more information about your business’s specific regulatory requirements through our regulatory services. 

2. Registration on CAQH ProView

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 Council for Affordable Quality Healthcare, CAQH ProView, to obtain your information. Therefore, you should have your profile registered. To avoid delays and rejections, you should fill out your application carefully with accurate data.

3. Submit Provider Enrollment Applications

Each provider will need you to submit an enrollment application. The process is different in their case. However, there are certain documents that you need to submit alongside the application in case of all providers. These include:

1. CAQH ID
2. Roster of clinicians (for group practices)
3. W-9 form
4. Attestation statements
5. NPI and Tax ID
6. Insurance declaration
7. Business license

There are online portals for application submission for most of the providers. 

4. Regular Follow-Ups and Maintenance of Records and Documents

The procedure of credentialing and certifications for businesses like outpatient clinics is a long one. There can be problems such as:

1. Documents getting misplaced
2. Portals glitch
3. Reviews stall
4. Delays

This is why you should be doing the following two things, without fail:

1. Take a follow-up every two weeks
2. Maintain a spreadsheet of submission dates, contact persons, ticket/reference numbers, and notes from calls

This can be eased with the help of the supportive professionals of Strategique Partners.

5. Maintaining and Re-credentialing 

The process of credentialing is an ongoing one. You need to get recredentialed every 2 to 3 years. Most of the providers require this. However, the recredentialed can be required sooner if any of the following changes about your behavioral health business:

1. License
2. Address, as part of your company development strategy 
3. Tax status

Common Pitfalls to Avoid in Getting Your Mental Health Business Credentialed

There are some common mistakes in the behavioral health market that you should avoid to get a quick credentialing. These include:

1. Forgetting to list all services and locations
2. Applying under the wrong NPI type (individual vs. organization)
3. Signing contracts without reviewing rates
4. Submitting incomplete CAQH profiles
5. Not following up frequently

How Strategique Partners Can Help You Avoid These Pitfalls and Delays in Credentialing?

Strategique Partners is an expert working in the mental health business market in the USA. It has helped businesses open and then grow into very robust and sustainable ventures. Our company development experts have helped smaller health businesses grow and expand or consolidate fragmented businesses. In all this, billing and financing remain our prime focus as we see it as the first major objective of behavioral health businesses, the second being serving a good cause. This is because, without a robust revenue stream, a business fails to serve the cause. 

You can ensure good revenue streams for your mental health business through insurance credentialing with the help of Strategique Partners.

Commonly Asked Questions Regarding Credentialing a Mental Health Business for Insurance Credentialing 

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

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

The credentialing process generally takes a long time. 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 specifically, depending on insurance billing for payments, 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 Telehealth Mental Health Businesses?

Credentialing requirements for telehealth mental health businesses are slightly more comprehensive. You often require multistate licensing and certifications. Furthermore, insurance providers have separate panels for telehealth service providers. This makes the credentialing process unique for telehealth mental health businesses.