Credentialing for Behavioral Health Providers

For behavioral health providers, this includes:

• Verification of your education and training
• Confirmation of state licensure and certifications
• Review of your clinical experience
• Checking your malpractice insurance coverage
• Verification of your DEA registration (if applicable)
• Investigation of any disciplinary actions or sanctions
• Confirmation of your work history
  

Here’s why credentialing is so important:

Insurance Reimbursement

The big one – without proper credentialing, you can’t receive payment from insurance companies. Today, being “out of network” can significantly limit your potential client base.

Professional Credibility

Being credentialed with major insurance networks signals to clients that you’ve met rigorous professional standards. It’s like having a seal of approval from established healthcare organizations.

Legal and Regulatory Compliance

Proper credentialing helps protect you legally and ensures you’re operating within all applicable regulations and standards of care.

Access to Referral Networks

Many healthcare systems and referral networks require credentialing before they’ll send patients your way.

Step 1: Gather Your Documentation

Before you even begin the application process, you’ll need to collect a mountain of paperwork.

Here’s your documentation checklist:

• Current CV/resume (with no gaps in employment history)
• All current state licenses
• Professional liability insurance certificate
• Proof of education and training
• Board certifications
• Letters of recommendation
• Immunization records
• Background check results
• DEA certificate (if applicable)
• Professional references
• National Provider Identifier (NPI) number
• Tax ID information

Tip: Create a digital folder with all these documents scanned and readily available. Trust me, you’ll thank yourself later.

Step 2: Complete the CAQH ProView Profile

The Council for Affordable Quality Healthcare (CAQH) ProView is like the Common App for healthcare credentialing. Most insurance companies use this standardized platform, so completing your CAQH profile thoroughly is absolutely crucial.

Key points about CAQH:

• Update it every 120 days minimum
• Keep all information current and consistent
• Include ALL practice locations
• Be meticulous with dates and details
• Regularly check your attestation status

*Providers: at Medwave, we allow you to create or update CAQH Pro-View accounts.

Step 3: Submit Applications to Insurance Companies

Now comes the fun part – actually applying to different insurance panels.

Each company has its own process, but generally you’ll need to:

1. Research which insurance panels are popular in your area
2. Submit a formal application to each company
3. Provide access to your CAQH profile
4. Complete any additional forms they require
5. Pay any applicable fees
6. Follow up regularly on your application status

Step 4: Primary Source Verification

This is where the insurance companies do their detective work. They’ll contact your schools, licensing boards, and previous employers directly to verify everything you’ve submitted. This process typically takes 60-180 days, depending on the insurance company and how quickly your sources respond.

Challenge 1: Time Management

Credentialing is incredibly time-consuming. Many providers underestimate just how many hours it takes to complete applications and follow up on them.

Solution: Consider hiring a credentialing specialist or using credentialing software to help manage the process. The investment often pays for itself in time saved and faster approval.

Challenge 2: Missing or Incomplete Information

One tiny gap in your employment history or missing document can delay your entire application.

Solution: Create a detailed checklist and timeline for each application. Set up a reminder system to ensure you’re gathering and submitting all required information on time.

Challenge 3: Keeping Track of Multiple Applications

When you’re applying to several insurance panels simultaneously, it’s easy to lose track of where each application stands.

Solution: Use a spreadsheet or project management tool to track:

• Application submission dates
• Follow-up deadlines
• Contact information for each insurance company
• Required documentation for each application
• Current status of each application

Challenge 4: Maintaining Credentials

Once you’re credentialed, you need to stay on top of renewals and updates.

Solution: Create a calendar with all important dates:

• License renewals
• Insurance policy renewals
• CAQH attestation deadlines
• Credentialing renewal deadlines for each panel
  

Behavioral health credentialing has some unique aspects that deserve special attention:

Specialty Classifications

Make sure you’re applying for the correct specialty classification.

Common options include:

• Licensed Professional Counselor (LPC)
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage and Family Therapist (LMFT)
• Psychologist
• Psychiatric Nurse Practitioner
• Psychiatrist

Supervision Requirements

Many insurance companies have specific requirements regarding supervision hours and documentation, especially for newly licensed providers.

Scope of Practice

Be clear about what services you’re qualified to provide under your license and credential for only those services.

Start Early

Begin the credentialing process at least 6 months before you plan to start seeing patients with insurance. This gives you plenty of time to handle any unexpected delays.

Be Thorough and Accurate

Double-check everything before submitting. A simple typo can result in significant delays.

Follow Up Regularly

Don’t assume no news is good news. Check in on your applications every 2-3 weeks.

Keep Detailed Records

Document all communications with insurance companies, including:

• Who you spoke with
• When you spoke with them
• What was discussed
• Any reference numbers provided

Stay Organized

Create a system for managing your credentialing documents and renewal dates from the start.

The credentialing landscape is evolving, with several trends worth watching:

Digital Transformation

More insurance companies are moving toward fully digital credentialing processes, making it easier to submit and track applications online.

Standardization Efforts

There’s a push toward more standardized credentialing processes across different insurance companies and healthcare organizations.

Telehealth Considerations

With the rise of telehealth, many insurance companies are updating their credentialing requirements to address virtual care delivery.

DIY Credentialing

Pros:

• Cost savings
• Complete control over the process
• Intimate knowledge of your credentialing status

Cons:

• Time-consuming
• Steep learning curve
• Potential for costly mistakes

Professional Credentialing Services

Pros:

• Expertise and experience
• Time savings
• Higher success rate
• Faster processing

Cons:

• Additional expense
• Need to verify service quality
• Still requires some involvement from you