Understanding Therapy Credentialing
Credentialing is a term used across various fields, but in this context, it refers to Therapy Credentialing or insurance credentialing, which are used interchangeably. Healthcare practitioners such as physicians, counseling offices, ABA therapists, speech therapists, mental health offices, social workers, and others who wish to bill insurance companies as in-network providers must undergo a credentialing process.
Get Credentialed with an Insurance Company
Complete the Credentialing Application:
Fill out the necessary credentialing forms provided by the insurance company.
Ensure all personal, educational, and professional details are accurately documented.
Submit Required Documentation:
Provide copies of your licenses, certifications, malpractice insurance, and any other required documents.
Include your CAQH (Council for Affordable Quality Healthcare) profile information, if applicable.
Primary Source Verification:
The insurance panel performs primary source verification to ensure that your credentials meet their minimum requirements.
This includes verifying your education, training, work history, and licensure status.
Background Check:
The insurance panel may conduct background checks, including criminal history and malpractice claims.
Review by Credentialing Committee:
A credentialing committee within the insurance company reviews your application and supporting documents.
They assess whether you meet their standards and criteria for becoming an in-network provider.
Notification of Credentialing Decision:
You will receive a notification of the decision. If approved, you move on to the contracting phase.
If additional information is required or corrections need to be made, you will be notified.
Contracting Phase:
Once credentialed, you enter the contracting phase where you negotiate and sign a contract with the insurance company.
This contract outlines the terms and conditions of your participation as an in-network provider.
Referral and Reimbursement:
As an in-network provider, you are eligible for referrals from the insurance company.
You will also receive preferential reimbursement rates for services provided to insured patients.
Direct Billing:
After completing the credentialing and contracting phases, you can bill the insurance company directly for services rendered.
Ensure compliance with the billing and coding guidelines specified in your contract.
Once the credentialing phase is complete, the provider’s application will be sent to contracting. At this time, the provider and the practice may be offered an “in-network” contract with the panel. If they are offered a contract, it will usually include the fee schedule and CPT codes for which the provider is eligible to bill.
At Cube Therapy Billing, we use the term credentialing to encompass both the credentialing and contracting phases of the credentialing process. Our credentialing specialists are trained to navigate both phases to ensure providers are properly on the panels.
The Benefits of Credentialing with an Insurance Company
The Evolution of Medical Credentialing and Its Importance Today
About twenty years ago, physicians and healthcare professionals considered medical credentialing (getting into insurance networks) optional for building a medical practice. Today, it has become necessary for providers to be networked with insurance companies. This is partially because more people in the U.S. have health insurance than ever before. Additionally, those health insurance plans cover more services than ever before.
Previously not covered pre-existing conditions are now necessarily covered by law. Insurance plans also have “mental health parity,” meaning they cover services provided by mental health counseling and psychiatric practices.
One notable way that insurance plans have changed is the reduction of “out-of-network” benefits. With out-of-network benefits, patients could choose any qualified provider and later file for reimbursement from their insurance company. Today, very few insurance plans have out-of-network benefits, and when they do, there are significant financial penalties for choosing an out-of-network provider.
Hence, patients look for in-network providers first, often starting with their insurance plan's preferred provider list.
Insurance Plans: Covering More Services Than Ever
Therapy credentialing is becoming more valuable as health insurance plans are broadening the scope of treatments they cover. These changes include mental health and behavioral health parity, fewer restrictions on pre-existing conditions, and coverage of supplemental services like physical therapy, massage therapy, and acupuncture.
The cost of health insurance in the United States has increased accordingly. Patients invest heavily in their health insurance plans and expect to use them for healthcare services, including general medical care, emergency medical care, dental, chiropractic, optometry, mental health services, and more.
Insurance Panels: Getting Full and Closing
As many healthcare professionals apply to join insurance networks, those networks are becoming full and sometimes even closing. This makes the process of medical credentialing more challenging. However, some panels that claim to be “closed” are just being highly selective about which providers they add. Knowing how to position your practice and expertise can go a long way in getting into “closed” panels.
Expertise in Licensure Process for Behavioral Health Providers
We are very familiar with the licensure process for a wide range of behavioral health providers, including:
Licensed Behavior Analyst (LBA)
Board Certified Behavior Analyst (BCBA)
Speech-Language Pathologists (SLP)
Licensed Professional Counselors (LPC)
Licensed Mental Health Counselors (LMHC)
Licensed Professional Clinical Counselors (LPCC)
Licensed Clinical Professional Counselors (LCPC)
Licensed Independent Clinical Social Workers (LICSW)
Licensed Clinical Social Workers (LCSW)
Licensed Psychologists
Licensed Marriage and Family Therapists (LMFT)
We understand that a designation in one state (such as LPC or LCSW) might not be interpreted as the same level of certification in another state. We can help you navigate the challenges these nomenclature variants can cause, ensuring a smooth licensure process across state lines.
Every year, we at Cube Therapy Billing provide Therapy Credentialing and Provider Enrollment services that help hundreds of practices (and thousands of providers) across the United States become credentialed with the best third-party payers.
Whether your practice is looking to join the preferred provider network with Blue Cross / Blue Shield or become paneled with Medicaid, our highly trained credentialing specialists can help.
For many providers, credentialing is a constant hassle. We, on the other hand, make credentialing easy.
Our Services Include:
Individual Provider Enrollment / Medical Credentialing (Getting on Insurance Panels)
Group Provider Enrollment
CAQH Completion and Management
Primary Source Verification
Re-credentialing
Credentialing Maintenance
Advantages of Credentialing with an Insurance Company
Our Simple 4-Step Credentialing Process
Onboarding: We make recommendations and help you select the insurance companies you want to be networked with. You complete our master survey and send in the applicable documentation.
Application: We obtain all up-to-date insurance applications and complete them on your behalf within five business days of receiving all necessary documentation from you.
Follow-Up: We follow up to make sure all applications have been received. We proactively follow up to ensure the enrollment process moves forward effectively and without delays.
Completion: We will inform you about all insurance approvals as soon as we receive confirmation. We will send you all applicable information from the insurance panel. You’re now ready to see clients and bill for services!
Conclusion
Therapy credentialing is essential for maintaining high standards of practice in the mental health field. By understanding the importance and process of credentialing, aspiring therapists can achieve their career goals and provide competent, ethical, and effective care to their clients. This guide offers valuable insights to help you navigate the credentialing journey successfully.