All the ways to Get Credentialed as a Therapist
In todays article I want to break down “credentialing” as a therapist in private practice. Consider this your quick start guide to all things credentialing. By the end of the article you will know if you want to get credentialed, where and how to get credentialed, and what to do once you are credentialed. Let’s go!
What is credentialing?
Credentialing or “being credentialed” as a therapist is the process through which you establish a contract with an insurance company. This contract states that you will provide mental health services to people with that insurance and the insurance company will pay you a certain rate for that service. In other words, being credentialed is the process of being able to accept insurance as a therapist.
Should you get credentialed?
Before we answer that question, we need to run through the pros and cons of accepting insurance. Let’s start with the cons.
Cons (Not exhaustive)
Insurance companies often reimburse “low” rates for services
Negotiating with an insurance company for higher rates can be difficult
You must abide by all of the regulations and stipulations an insurance company requires, some of which don’t make sense (treatment frequency, treatment duration, documentation, etc.). Abiding by these regulations can eat into your time
Insurance companies may audit your practice, deem something unnecessary, and require payback
Pros (Non exhaustive)
You increase access to quality mental health services
You can reach more potential clients allowing your practice to grow
The decision to accept insurance is a personal one. If you want to provide accessible care to people, expand your reach, and grow your practice, accepting insurance is most definitely going to be helpful. However, if you are interested in being all cash pay and avoiding unnecessary administrative tasks, then forgoing insurance may be better for you. The latter route may require an emphasis on marketing, niching down, and networking.
How do you get credentialed?
There are several ways to be credentialed. Let me break it down for you.
Sign up with a company like ALMA, Headway, Grow, etc
There are a few start-up companies that have made the process of credentialing simpler than ever. Let’s use ALMA for example. If you sign up with ALMA, they will do all of the work required to get you credentialed. You fill out an application for them and they do the rest. They negotiate the rates, they interact with the insurance company, and they even provide you a platform to do your billing. Not to mention, they tend to negotiate higher rates than an individual can. These companies also pay you directly and on time. If you credential on your own, some insurers send paper checks that you have to deposit. Moreover, there can be quite a delay between submitting a claim and receiving payment. These companies have made the process of credentialing quick. You can be credentialed with some insurers in about 30 days.
For the most part, this method is great. There are a few drawbacks worth mentioning. For one, some of the companies charge a monthly fee to join. Second, if you look to expand to a group practice, these companies wont work too well. In particular, they don’t allow incident-to billing. Lastly, if you no longer want to work with a company like ALMA and leave, you will no longer be credentialed.
Credential yourself
At the end of the day getting credentialed with an insurance company can be done independently. This typically involves going to an insurers website and filling out the application. It’s also free. Additionally, once you credential with them, you have your own contract. Some insurers also allow incident-to billing, which can help if you decide to hire provisionally licensed folks. However, there can be road blocks to this approach. It can be confusing and it can take a long time. Some insurance companies can take 6 or more months to complete the credentialing process. Yikes!
Hiring a company to credential you
Finally, you can work with a credentialing company. This is the same as credentialing yourself, however, the company works on your behalf eliminating the administrative burden and freeing up your time. They can also help negotiate rates. The downside of this is that it can be costly. I used GreenPoint Med to credential my practice. They did quality work, but there are many options out there. Just be sure to read the reviews.
What to do once you are credentialed?
Make sure to indicate on your directories, website, etc. that you take insurance. Many therapy seekers are specifically looking for therapists that take their insurance. It is crucial to have this detail up to date on all your profiles.
If you use a service like ALMA, Headway, etc, it is quite simple. These companies provide you with a platform to do all your billing. It may take a bit to get familiar with their platform, but once you do, it is only a few clicks to submit a claim. Not to mention they will help you with any kickbacks or audits that come your way.
If you credential on your own and have your own contract, you will need to learn how to bill and submit claims or you will need to hire a biller. Learning how to do insurance billing can be complicated and require some time, however, it is doable. I currently run a consultation group that includes a biller who is there to answer questions and point you in the right direction. She is the way I learned how to bill and submit claims for my practice. If you are interested in learning about credentialing and billing, consider joining the consultation group. Check it out here…
