5 Keys to Insurance Credentialing for Mental Health Providers

Introduction

Credentialing is important for the mental health providers that let them become certified and provide professional services to the patients. It provides healthcare providers with the opportunity to become affiliated with an insurance company. These service providers are in turn reimbursed by a third party i.e. patients through the insurance company.

This guide provides you with detailed information about the keys to insurance credentialing for mental health providers. Whenever we want credentialing services, we always look for an authentic, certified, and experienced service provider so that we could get quality services.

Let us have a look at the keys that are necessary for a mental health provider to get credentialed:

1.  Contact a Professional Insurance Company

First, it is important for the mental health provider to contact a professional insurance company to start the process of credentialing. There are different insurance companies and panels available out there where all these insurance companies are not equal. You should know that it takes about 180 days to complete the insurance credentialing process as it is a time-consuming task.

You need to select a company that could be beneficial for you in the future regarding your practice so that the patients could be served well. You can ask for referrals or search for a reputable insurance company in your area whose insurance would cover all the mental health services.

2.  Consider The Necessary Documentation

The consideration of necessary documents required for the credentialing process is also necessary. You need to know about the documents that are required by different insurance companies. You have to submit complete applications to make sure that you are serious about getting credentialed.

You must be thinking how I could ensure all my applications are complete. Let us tell you that you need to enlist all the insurance providers you have planned to file with. Then, you need to write all the documentation required by each insurance provider.

The necessary information may include career history, education, demographic information, name, social security information, claim history and much other necessary information. Most of this information is provided in your resume so make sure all the requirements are fulfilled when you submit your location.

3.  Focus On Accurate Information

You need to focus on providing accurate information to the insurer when submitting your application. No doubt, the quality, and accuracy of the provided information are considered the key to getting credentialed. You need to review the information twice before submitting it.

Before submitting your application to any insurance company, you need to conduct a background check. You need to review your educational history, reputation, board certification, and licensing through the healthcare companies such as ECFMG, OIG, AMA, etc.

You need to check for all the errors in your documents. There might be an error in dates and months of employment which can cause an issue for you in getting credentialed. You need to make sure that you have provided the correct phone numbers for references. After cross-checking and making sure all the data is accurate, you can submit your credentialing application.

4.  Completion of CAQH

You may see that there are many insurance companies that require partner facilities for applying to get credentialed. It means they require credentialing through the Council for Affordable Quality Healthcare. You are provided with a CAQH number and an invitation for applying for credentialing once your facility is done with filing an application with an insurance company.

The insurance company also provides you with an option for completing the CAQH form online or on a piece of paper. It would be best if you fill these 50 pages on a computer. When you are done with the submission of the initial application, you need to re-attest.

If there is an issue with the provided information, the approval of CAQH may be delayed. Moreover, if you want to continue the insurance eligibility, it is necessary for you to attest that the information provided by the mental health provider is accurate and correct four times each year.

5.  Get Verified

When you submit your application to the insurer making sure that all the information is correct and accurate, you need to wait for the approval of the insurance company. You may have to wait for some days as it is a time-consuming and lengthy process.

It may take about ninety days for the completion of this procedure but you may also have to wait for about 150 days. We cannot expect when this procedure will be completed, you just have to wait after the submission of your application.

Waiting does not mean you have to have it for 5-6 months. If it takes that much longer, you should contact the insurer. You can do it by sending an email or calling the insurer on the phone to find out the reason why you have not been credentialed yet.

FAQs

Why is credentialing service necessary?

Credentialing is important for mental health providers to become affiliated with insurance companies to get hired by third parties.

How much does it cost to credential with an insurance company?

It costs about 2000 dollars to 3000 dollars per year for getting credentialing services from an insurance company.

What is meant by a credentialed healthcare service provider?

A credentialed healthcare service provider is one who consists of the health insurance and assesses the qualifications of a provider.

Conclusion

You should be aware of the importance of credentialing mental health providers. They need to get credentialed to get providers’ qualifications and improve trust among the patients.

It ensures the patients that they will be provided with quality services in a professional manner. Some keys are needed to be considered for insurance credentialing for mental health providers that have been discussed in this guide.