How to Get Credentialed with Insurance Companies Mental Health

How to Get Credentialed with Insurance Companies Mental Health

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Insurance credentialing is one of the most important avenues for growing a mental health treatment center. Once you have crossed this hurdle and become part of an insurance provider network, you can truly begin to expand your reach. Read on to learn how to get credentialed with insurance companies, mental health specifically.

Learn About Insurance Credentialing

As most consumers are aware, when it comes to locating healthcare providers and specialists, the insurance network directory becomes an essential tool. Insurers are careful to cull the candidates that apply to their network in order to select the best fit for their insured. This selection process involves two steps: credentialing and contracting.

The credentialing piece, also called “paneling,” has to do with meeting the insurance company’s requirements. Only after a mental health provider demonstrates the various licensure and compliance requirements are met can a practice be invited to join. The contracting piece involves negotiating a fee schedule that is agreeable to both parties.

Learning how to get credentialed with insurance companies mental health directory is a key to a provider attaining fiscal health. After a major insurer accepts your mental health practice into its network, consumers seeking mental health services can find you. This provides a lucrative channel for growing your practice and your revenue stream. First, though, you have to engage in a sometimes challenging and time consuming credentialing process.

What is the Purpose of Mental Health Credentialing?

Insurance companies offer their customers access to a curated provider network, which is the product they are selling. The insurance companies need the participating providers, and vice versa, so these networks are a win-win for both.

From the insurer’s vantage point, credentialing helps ensure that they are offering qualified mental health providers to their customers. Because paneling is so competitive, the credentialing process can help raise the bar among providers who want to be included. Thus, it protects the consumer by weeding out the unqualified providers, and then rewards the newly contracted providers with access to more clients.

Credentialing Guide for Mental Health Providers

The credentialing process is quite intricate, requiring patience and time. Providers going through this process should expect it to take several months with unforeseen challenges. It is entirely possible for a mental health practice to undertake this challenge on its own. However, keep in mind that credentialing consultants are available to relieve the burden of this cumbersome endeavor.

Here is a handy guide to assist you in the credentialing process:

  1. Gather your documents. The process begins with an application that will require lots of documentation. Be prepared to have these documents on hand: Current licensing in the state where the practice is located
  2. Select insurance companies. Consider which insurance companies are most prevalent in your region, are they reputable, their reimbursement rates, and how long approval takes.
  3. Complete applications. You will need to apply separately to each insurance company.
  4. Follow up. Be sure to check back in a week to ensure they received your application, and ask if they need anything else.
  5. Re-apply if rejected. Often an insurance company has too many mental health practitioners and therefore rejects your practice. Be aware that you can reapply at a later date, as these networks do change.

If your application is accepted, then it’s time to begin the contracting phase of the process. This is when you are often able to negotiate the reimbursement rates. Once you have agreed upon a rate and have signed the contract, your practice is then listed on the network.

Insurance Company Credentialing Challenges

When learning how to get credentialed with insurance companies mental health, it is a good idea to be prepared. Here are some of the common challenges you might encounter:

  • Time-consuming. When you begin the application process you will soon realize that it is very time consuming. It takes time to collect all the documents and meet the various requirements, such as COQH and getting a tax identifier. Once you have submitted the application, it takes about six months to hear back.
  • Detailed. Prepare to follow every step exactly as instructed or your application will be denied. Missing documents or errors only set the whole process back, making it take even longer.
  • Competitive. Getting paneled is not a slam-dunk, as these networks are highly competitive. Improve your chances by offering evening or Saturday hours, crisis services, or a special niche area of expertise.

Outsourcing Insurance Company Credentialing to a Consultant

If the credentialing process seems daunting, you might want to look into hiring a credentialing consultant. These are consultants that specialize in credentialing and contracting, so they know how to navigate the terrain.

Credentialing consultants are aware of the common missteps that can trip up the application process and save you a lot of time and frustration. They are also experienced in contract negotiation, netting you a better reimbursement rate that you could get on your own.

The time you save by outsourcing the credentialing process can be used to focus on hiring and refining your program. Also keep in mind these are tax-deductible services as a cost of doing business.

Mint Billing Offers Credentialing Support

Mint Billing is a consultancy that specializes in assisting mental health and behavioral health providers. Our credentialing experts offer an important resource for mental health providers looking into how to get credentialed with insurance companies. For more information or learn more about our services, please reach out today at (877) 715-7919
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How to Bill for Behavioral Health Services

How to Bill for Behavioral Health Services

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Billing for behavioral health services is an integral function of any organization that provides services for mental health or addiction recovery. As the primary mechanism for receiving payment from insurance carriers, billing must adhere to payer compliance requirements. The result of not adhering to the rules of the billing process may cause the payer to:

  • Deny the claim, putting the facility at risk of not receiving payment
  • Request an audit on the provider
  • Require the organization to make payments back to payer

For these reasons and more, it is crucial to understand exactly how to bill for behavioral health services.

About Behavioral Health Billing and Coding

It is important to understand the difference between behavioral health billing and medical billing. First off, know that insurance payers impose greater restrictions on billing practices for behavioral health versus mental health. In addition, the coding itself is far more complex for the billing of behavioral health services.

The behavioral health billing and coding process is based on something called Current Procedural Terminology (CPT). These are billing codes used for services related to behavioral health screening, treatment, and preventative services. Assigning the precise code for the service rendered is critical for claims to be paid.

Types of CPT Codes

The American Medical Association provides CPT codes that pertain to the behavioral health continuum of services. The codes are broken down in to detailed descriptions of services. Examples include the length of a psychotherapy session, or a psychiatric diagnostic evaluation with or without medical services.

These four categories of CPT codes include:

  • Category A: Counseling Risk Factor Reduction and Behavioral Change Interventions. These include various codes for:
    • Preventative Medicine
    • Behavioral Change Interventions
  • Category B: Do Not Require Larger Collaboration Outside of Practice. These include various codes for:
    • Psychotherapy
    • Developmental Behavioral Screening
  • Category C: Increased Collaboration Under Integrated Care. These include various codes for:
    • Adaptive Behavior Services
    • Health Behavior Assessment and Intervention
  • Category D: Most Comprehensive Code for and Expansive Coordination Model. These include various codes for:
      • General Behavioral Health Integration Care Management
      • Psychiatric Collaborative Care Management
      • Cognitive Assessment and Care Plan Services
      • Inter-Professional Digital Services
      • CoCM General Management  (Medicare)

Guide to Billing for Behavioral Health Services

Behavioral health billing can be time consuming and confusing. However, the process can be broken down into the following four basic steps:

  1. Collect Client Demographic and Insurance Information. To initiate the insurance claim process, you must first collect the required patient demographic and insurance information. Some insurance plans restrict the number of sessions delivered per year by mental health or addiction treatment provider.
  2. Checking Patient Eligibility and Benefits. Once the intake data is collected, you will call the patient’s insurance carrier to verify eligibility and benefits. After you have received this information, you can inform the patient of their coverage for services.
  3. Code and Submit Claims for Services Rendered. You will then need to assign a CPT code or codes to the claim form. It is important to be very careful in selecting the correct CPT code to avoid any errors in the claim process. This coding pertains to the type of service being rendered. In addition to the CPT, you must select the appropriate ICD-10 diagnostic code (specific coding for behavioral health diagnoses). The ICD-10 refers to the patient’s specific disorder.
  4. Handle Claim Denials and Appeals and Submit Corrected Claims. A claim may be rejected at one of two junctures: the Clearinghouse level or at the insurance carrier level. Claims are denied for the following reasons:
    • Terminated coverage
    • A coordination of benefits issue
    • Unauthorized treatment sessions
    • Untimely filing

Correct the errors and re-file the claims. Claims that cannot be resolved must then go through the appeals process.

How to Bill for Behavioral Health Services

Common Problems in Billing for Behavioral Health Services

As careful as you are when billing for services, errors or unforeseen problems may cause the claim to be denied. Here are some common challenges for behavioral health billing – or how not to bill for behavioral health services:

  • Choosing the wrong codes. A CPT or ICD-10 is selected that doesn’t reflect the actual services performed or patient diagnosis. This results in denial of claim.
  • Upcoding or unbundling. Upcoding refers to inappropriate billing practices that use higher-level codes than the actual service provided. Unbundling refers to billing for services separately that should be bundled.
  • Insufficient documentation. This is the case when clinical notes to support the billed services are not provided to the insurance company. Also, not including the correct patient data will also lead to delays or denials of processing claims.
  • Not adhering to payer requirements. Each insurance company has very specific billing guidelines that providers must follow. Not adhering to these rules results in claim denials, or even being dropped from the network.
  • Not obtaining pre-authorizations. Insurance companies often require a pre-authorization is obtained prior to initiating the service.

Benefits of Outsourcing Behavioral Health Billing

In some cases, usually with a large organization, the provider has an employee who is solely dedicated to managing the billing. That is their full-time job. However, chances are it’s the clinicians or office personnel pitching in to handle billing, which is when errors happen.

A behavioral health billing service can eliminate many of the problems associated with the tedious job of billing insurers. This third-party service provider has the expertise to streamline the entire billing process. These billing professionals help providers stay current on insurance credentialing and billing requirements. This frees up the provider from this time-consuming work, allowing them to care for patients.

Some of the many benefits of utilizing a behavioral health billing service include:

  • Maximizing reimbursements and minimizing claim denials
  • Ongoing compliance monitoring
  • Navigating the unique billing challenges in the behavioral health sector
  • Optimizing revenue cycle management
  • Providing customized reporting and analytics
  • Providing insights into the facility’s overall financial health

So, you are now informed about how to bill for behavioral health services. You might agree that handing this demanding task over to a billing professional might be worth considering.

Mint Billing Expert Billing Services for Behavioral Health Facilities

Mint Billing offers billing solutions for providers of behavioral health treatment services. To learn more about how our billing service can benefit your facility, please reach out today at (877) 715-7919.

Welcome to Mint Billing

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At Mint Billing, we believe mental health and substance abuse treatment facilities should focus on what truly matters—caring for patients.

That’s why we’re here, working tirelessly behind the scenes to simplify and optimize the revenue cycle management process. 

With over 30 years of combined experience in behavioral health and revenue cycle management, we’ve made it our mission to support treatment facilities every step of the way. From verifying benefits and pre-authorization to claims processing, payment tracking, and appeals, we handle it all. What sets us apart is our clinician-based utilization department, fiercely advocating to ensure that care is never compromised by insurance roadblocks.