Insurance credentialing is an important, intricate process that results in you becoming a “paneled,” in-network provider for a health insurance plan. Credentialing can help your behavioral health practice bring in more patients and more revenue, but it can take several months or longer and involve many frustrations and hurdles. In this article, we will explain how to get credentialed with insurance companies using the three most common methods.

Understanding Credentialing

Credentialing is a process by which you establish your qualifications and legitimacy with a provider network or healthcare institution. You must already be a fully licensed clinician to begin the credentialing process, and you may need to undergo credentialing multiple times with different insurance companies or government agencies (e.g., Medicare).

Credentials are important for establishing a reliable stream of patients and revenue for your mental health, therapy, or psychology practice. The process usually ends with negotiating your terms of a contract and fee schedule. Credentialing can easily take 3–6 months, so make sure to start the process early, especially if you are opening your own practice.

The 3 Paths to Credentialing

Credentialing is a vital piece of your business that involves many hurdles and details, and it also involves a negotiation process for your fee schedule and other terms. For these reasons, many providers choose to outsource the process to a credentialing specialist or billing agency, although you may also decide to do it yourself. Let’s explore these 3 options.

1. Outsourcing to a Credentialing Consultant

A credentialing consultant is a specialist who can help you prepare and submit the required forms, to go back and forth with the insurance company or government agency to ensure all requirements are met and that they process your application promptly, and even to negotiate elements of your contract, such as your fee schedule, and whether your contract will be backdated so that you can begin treating patients sooner.

Credentialing consultants may work individually, or as part of a larger agency. Because of their expertise and experience, hiring a consultant may result in better approval odds, a faster credentialing process, and a higher-paying fee schedule. A drawback of this path is the additional cost. Also, it may be difficult to find and choose the best consultant.

2. Outsourcing to a Multi-Purpose Medical Billing Agency

A multi-purpose medical billing agency may offer credentialing along with a suite of services that may include billing, records management, and practice management. These agencies are typically more expensive but offer an array of services that may allow you to focus more on your work with patients without having to select multiple vendors or waste time on tasks that are outside of your wheelhouse.

One drawback is that although there may be a “one-stop shop” bundling discount, these platforms and their staff may lack the specialized expertise of dedicated credentialing consultants.

3. Doing It Yourself

Doing it yourself is a viable option, particularly if you are patient and detail oriented. Step-by-step guides from websites such as Medical Credentialing, and even online forums such as Reddit, may help answer your questions along the way. Check out our article about credentialing for more information.

The downsides of this approach are that you will have to dedicate 10 hours or longer of focused work for each panel you are applying to, and that you may hit snags, or your application may get lost in limbo. A consultant would know how to avoid these hiccups and follow up for manual processing at the opportune time. The vital piece of negotiating your fee schedule may also benefit from professional help.

On the other hand, the benefits of doing it yourself are that you will gain expertise that will be useful for future credentialing applications and re-credentialing, which typically needs to be done every 2 years. Furthermore, you will be putting together papers and files that you will need anyway, such as your medical license, proof of insurance, references, CAQH number, DEA number, NPI number, and EIN.

Conclusion

The credentialing process is a key part of launching or enhancing your behavioral health practice. Although it is full of hassles, it can be simplified with the right approach and by doing your homework or employing an outside consultant or vendor.

Here, we discussed three approaches to credentialing along with some of the major players, strategies, and concerns. Whether you are a behavioral health provider, clinical director, or allied professional, we encourage you to learn more about the credentialing panels in your area and clinical specialty!