What is Medical Credentialing? What is Insurance Credentialing?
Credentialing in general is used in various contexts in different fields. In this instance, the term credentialing refers Therapy Credentialing or insurance credentialing. Both Therapy Credentialing and insurance credentialing are used interchangeably. Physicians and other healthcare practitioners such as a counseling office, ABA Therapist, Speech Therapist, Mental Health office, Social worker etc, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.
Once a provider is credentialed with an insurance company, they can bill that company directly. In addition, most insurance panels will also provide “in-network” providers with referrals and preferential reimbursement rates. Many panels split the credentialing process into two parts. There is a credentialing phase and a contracting phase. During the credentialing phase, an insurance panel will perform primary source verification on a provider to make sure that the provider meets the minimum requirements of the panel. In addition, the panels may access the CAQH to assess the providers' education and employment history.
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 credentialing and contracting phases of the credentialing process. The credentialing specialists are trained to navigate both credentialing and contracting to ensure providers are properly on the panels.
Patients Want to Use their Insurance
About twenty years ago, physicians and healthcare professionals alike still considered medical credentialing (getting in insurance networks) to be optional for building a medical practice. In contract, today it’s become more necessary than ever for providers to be networked with insurance companies. This is partially because more people in the U.S. have health insurance than ever before. And in many ways, those health insurance plans cover more than ever before. One can go to healthcare.gov to read that previously not covered pre-existing conditions are now, by law, necessarily covered. One can also see that insurance plans also have “mental health parity” which means insurance plans cover services provided by mental health counseling and psychiatric practices. One notable way that insurance plans are more limited than in years past in the absence of “out-of-network” benefits. When one has out of network benefits one doesn’t need to choose a provider who is in network. Instead, the patient can select any qualified provider and later file for reimbursement to his/her insurance company. Today, in contrast to years past, very few insurance plans have out-of-network benefits, and then they do (again, very rare), there are significant financial penalties to the patient for choosing an out of network provider. Hence, patients look in network to find a provider—sometimes the first place they look for a doctor or healthcare provider near them is their insurance plans preferred provider list.
Insurance Plans: Covering more Services than Ever
Therapy credentialing is becoming more valuable as health insurance plans are becoming broader in regards to the scope of treatments they cover. These changes include mental health and behavioral health parity, as well as fewer restrictions on pre-existing conditions and the coverage of supplemental services. These services include physical therapy, massage therapy, acupuncture and others. However, the cost of health insurance in the United States has increased accordingly. Persons invest heavily into their health insurance plans, and you better believe when they need healthcare services—be it general medical care, emergency medical care, dental, chiropractic, optometry, or mental health services, or anything—patients desire (even demand) to use their health insurance plans when seeking those healthcare services.
Insurance Panels: Getting Full and Closing
Unfortunately, as droves of healthcare professionals apply to join insurance networks, those networks are increasingly becoming full (and sometimes even closing), which means the process of medical credentialing is becoming more challenging every day. That being said, some panels that claim to be “closed” are really just being highly selective about which providers they are adding. Knowing how to position your practice and expertise can go a long way when it comes to getting into “closed” panels.
We are also very familiar with the licensure process 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), and many others. We understand that a designation in one state (such as LPC, LCSW) might not be interpreted as the same level of certification on another state and we can help you navigate the challenges these nomenclature variants can cause.
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 3rd party payers.
Whether your practice is looking to join the preferred provider network with Blue Cross / Blue Shied or is looking to 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
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 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!