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Credentialing & Insurance

The credentialing process for mental health professionals seeking to work with insurance providers involves a series of steps to ensure that the practitioner meets the necessary qualifications and standards. This process is crucial for establishing a provider's eligibility to deliver services and receive reimbursement from insurance companies.

Credentialing Process Overview

  1. Educational and Professional Qualifications: Mental health professionals must meet specific educational and professional requirements. This often includes holding a relevant degree (such as a master's or doctoral degree in psychology, counseling, social work, or a related field) from an accredited institution.

  2. State Licensure: Mental health providers must be licensed to practice in the state where they plan to offer services. State licensure ensures that the practitioner has met the required standards for education, training, and professional competence.

  3. Clinical Experience: Insurance companies typically require mental health professionals to have a certain amount of supervised clinical experience. This may involve completing a specified number of supervised clinical hours and, in some cases, demonstrating expertise in specific areas of mental health.

  4. National Provider Identifier (NPI): Mental health professionals need to obtain a National Provider Identifier (NPI), a unique identification number assigned to healthcare providers. This number is used for billing and identification purposes in electronic transactions.

  5. Professional Liability Insurance: Many insurance companies require mental health professionals to carry professional liability insurance. This insurance protects both the practitioner and the client in the event of a malpractice claim.

  6. Application Submission: Mental health professionals interested in becoming credentialed providers with an insurance company must submit a comprehensive application. This application typically includes details about the provider's education, licensure, certifications, experience, and other relevant information.

  7. Verification of Credentials: The insurance company will verify the credentials provided by the mental health professional. This process may involve contacting educational institutions, licensing boards, and other entities to confirm the accuracy of the information provided.

  8. Panel Approval: Once the verification process is complete and the mental health professional is deemed eligible, they may be added to the insurance company's panel of approved providers. Being on the panel means the provider is officially recognized and can offer services to clients covered by the insurance plan.

  9. Contract Negotiation: After approval, the provider may need to negotiate a contract with the insurance company, outlining terms such as reimbursement rates, covered services, and other relevant details.

  10. Regular Re-Credentialing: Credentialing is not a one-time process. Mental health professionals are typically required to undergo periodic re-credentialing to ensure they continue to meet the insurance company's standards. This may involve submitting updated information on education, licensure, and other relevant factors.

It's important for mental health professionals to be proactive in the credentialing process to ensure timely approval and the ability to work with a diverse client base covered by various insurance plans. The specific requirements and procedures may vary among insurance companies and states.

Credentialing Submission Form

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Disciplinary Actions
Insurances you wish to be credentialed with
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Credentialing Costs are per payer:
  • $25 add a clinician
  • $125 for individual
  • $175 for groups
  • Individuals are responsible for setting up and managing their own CAQH
Billing Services Available 7% of billing
  • Benefits & eligibility checks
  • Submit Insurance claims
  • Post Payments
  • Work denied claims
  • Provide spreadsheet of monthly payments
  • Any additional insurance needs
$

Click here to download

Credentialing Help
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Ohio Provider Directory & Provider Portal Links:

Availity:  (800) 282-4548 

Change: (866) 371-9066

Aetna Commercial: (800) 353-1232 #3

Aetna Medicaid: (833) 711-0773

Aetna Medicare: (800) 624-0756

Allied: (888) 781-0585

Amerihealth: (833) 644-6001

Anthem Commercial: (833) 639-1634

Anthem Medicaid (OH): (220) 212-8851

Anthem Medicare: (800)676-2583

Buckeye Health plan: (866) 296-8731

Caresource: (800) 488-0134 #6

Cigna: (800) 997-1654

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Humana Medicaid: (877) 856-5707

Humana Medicare: (844) 291-2162

Medical Mutual: (800) 625-2583

Molina: (855) 322-4079

Mutual of Omaha: (800) 228-7104

Ohio Medicaid: (800) 686-1516

Optum VA:  (844) 839-6108

Oscar: (800) 235-3149

Oxford: (800) 666-1353

Paramount Advantage

Tricare: (866) 773-0404

United Healthcare: (877) 614-0484

United Behavioral Health: (877) 842-3210

United Healthcare Optum: (877) 842-3210

Insurance Credentialing 101

Step by Step Credentialing

Credentialing & Contracting

Credentialing for Therapists

Setting up CAQH

Medicare Provider Number, PTAN

Medicare/ Pecos Enrollment

Applying for an NPI

Billing for Beginners

Billing 101

Minute Billing

Revenue Cycle Management (RCM)

Electronic Health Record Options

TherapyNotes:

First Clinician:$59/month

Additional Clinicians:$30/month

Schedulers/Billers:Free

Clearinghouse Services

Real Time Eligibility Requests: $0.14 each

Electronic Claims: $0.14 each

Remittance Advice (ERAs): $0.14 per claim

Mailed Paper Claims: $0.49 each

Email Reminders: Free

SMS (Text Message) Reminders:$0.14 each

Automated Phone Reminders:$0.14 each

Telehealth:  Free

TherapyNotes ePrescribe: Each Prescriber:$65/month

 

Simple Practice

Stater Plan: $29/mo.              

Unlimited clients

Paperless intakes

Client portal

Progress notes

Diagnosis and treatment plans

Automated invoicing and billing

Credit card processing

Live customer support

Mobile app

Telehealth Add for $15/mo

 

Essential Plan: $69

Everything in Starter, plus:

Customizable notes and assessments

Appointment reminders

Online appointment requests

Secure client messaging

Monarch directory (practitioner directory)

Professional website

Analytics dashboard

Insurance claim filing (starting at $.25/claim): 10 claims included/mo

Wiley Treatment Planner: Add for $15/mo

Telehealth Included

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Essential Plus Plan: $99/mo.

Calendar sync

Appointment request widget

Advanced calendar filters

Add team members

Add practice managers ($39/mo per person)

Add clinicians ($59/mo per person)

Insurance claim filing (starting at $.25/claim) 35 claims included/mo

Wiley Treatment Planner Included

Telehealth Included

 

Wiley Practice Planners

Build effective, well documented treatment plans with Wiley PracticePlanners®. Access the treatment plans, progress notes, and homework assignments that are already seamlessly integrated into your EHR system. Wiley PracticePlanners® offer comprehensive treatment approaches that can be customized for individual needs.

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Therabill

$149 per month/per provider

+ $199 one-time setup cost

Your membership includes:

  • Unlimited non-provider logins

  • Unlimited email support

  • Unlimited claims, scheduling, and documentation

  • 2 GB of attachment storage

  • Online training and onboarding

  • No per-claim or clearinghouse costs

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My Clients Plus

Monthly Plan

$29/month per provider

  • Unlimited clients

  • Multi-user access to your account.

  • Multiple office location support.

  • Unlimited email reminders

  • In-depth reports to keep track of revenue, number of sessions,
    type of session and other metrics important to your practice.

  • Credit card processing.

  • Generate invoices and superbills with ease.

  • Client portal access included for first provider

  • $5/monthly claim subscription

  • • Includes 10 claims, additional claims are 25¢ each

Enrollments
  • $5 per payer enrollment for annual plan subscribers

  • $10 per payer enrollment for monthly plan subscribers

Add Ons

  • Wiley Practice Planners: $25 per month, per provider
  • Telehealth: $15 per month, per provider
  • Appointment Reminders: Price Varies for SMS Text and Voice Reminders. Email Reminders Free.
​

Annual Plan

$319/year per provider

  • Unlimited clients

  • Multi-user access to your account.

  • Multiple office location support.

  • Unlimited email reminders

  • In-depth reports to keep track of revenue, number of sessions, type of session and other metrics important to your practice.

  • Credit card processing.

  • Generate invoices and superbills with ease.

  • Client portal access included for first provider

Claims Processing: $5/monthly claim subscription, Includes 10 claims, additional claims are 25¢ each

Enrollments
  • $5 per payer enrollment for annual plan subscribers

  • $10 per payer enrollment for monthly plan subscribers

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TheraNest

Cost:

  • 30 Active Clients: $39

  • 40 Active Clients: $50

  • 50 Active Clients: $60

  • 80 Active Clients: $91

  • 100+ Active Clients: 205-537-9167

Add Ons:

  • Wiley: $25/ per user

  • Client Portal: $6 per therapist

  • Telehealth: $12 per therapist

Features:

  • Unlimited staff members

  • World class customer support, including live phone support

  • Full-featured calendar that keeps you organized

  • Automatic email, phone, and text appointment reminders*

  • Client Portal with client self-scheduling

  • Customizable Intake Forms

  • Integrated credit card processing that allows you to store and charge cards

  • Batch Payments feature for easy payment collection

  • Robust reporting features with over 25 reports available

  • Eligibility Checks for TheraNest Pro and TheraNest Enterprise (Apex Customers Only)

  • Unlimited note templates with Custom Forms

  • Seamless client and insurance billing

  • Electronic claims filing*

  • Integrated ERA/ EOB

  • Comprehensive knowledge base with articles, videos, and on-demand training

  • HIPAA compliant secure messaging

  • Unlimited document storage for clients and staff members

  • Customizable superbills and client statements

  • Practice chat for secure internal communication

  • iPhone and Android mobile apps available

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Kareo

  • Comprehensive Dashboard: Enjoy intuitive dashboard, task lists, and customizable multi-resource calendar.

  • Simple Charting: See how simple and fast it can be to create patient encounter notes.

  • E-Prescribe: Save time and eliminate phone calls for you and your staff with electronic prescribing. 

  • Convenient eLabs: Automate inefficient paper based processes

  • Electronic Superbills: Complete and submit an accurate superbill in just a few clicks.

  • Integrated Patient Portal: Share medical records and billing information and communicate with patients securely at any time.

  • Secure Messaging: Conveniently message anyone in your practice, your biller or billing team, even your patients.

  • Meaningful Use Stage 2 Certified: Meet the highest standards for maintaining data confidentiality and secure sharing of information.

  • ICD-10 Ready: Trust Kareo to guide you and your practice through a successful ICD-10 transition.

  • Maximize productivity:Support your staff's entire practice workflow including managing patients, uploading documents and sending secure messages.

  • Flexible Calendar: Save time and customize your schedule so your front office can easily manage important patient communications.

  • Agenda Overview: Get complete visibility at a glance by showing you outstanding items that need your attention for the day.

  • Integrated Prescription Discounts:Search and compare prices at the point of prescribing. Increase likelihood of patients filling their prescriptions by providing them with discounts to save money.

  • Flowsheets: Easily review and make necessary adjustments to individual lab and vital trends on one screen while getting a holistic view of your patient's key data over time.

Pricing

  • Full Platform plus 50 claims/month: $174/month (each additional claim is only $0.99 cents)

  • Full Platform plus Unlimited claims/month: $224/month

  • Typical Promotional Offers: 50% off your first 4 months, plus Free Dedicated Success Coach for your first 90 Days

  • No Startup Costs

  • No Hidden Fees

  • Free and Unlimited Live Support

  • Free Training and Onboarding Assistance

​

TheraPlatform

Basic $ 39

can not add additional providers

  • Unlimited Clients

  • Scheduling

  • Documentation

  • Billing

  • Unlimited Telehealth

​

Pro $ 49

$39 each additional provider

  • Unlimited Clients

  • Scheduling

  • Documentation

  • Billing

  • Automated Billing

  • Insurance Billing

  • Unlimited Telehealth

  • Telehealth Tools

​

Pro Plus $ 59

$49 each additional provider

  • Unlimited Clients

  • Scheduling

  • Documentation

  • Billing

  • Automated Billing

  • Insurance Billing

  • Unlimited Telehealth

  • Telehealth Tools

  • Interactive Therapy Apps

​

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Billing e-Guide

Each payor will require you to complete a W9, here is the link

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Mental Health Resources Map

Belongly link 

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Credentialing For Hire: 

PLEASE NOTE.... Hiring an outside company to do your credentialing is costly, time consuming and confuses the process. You are better off credentialing yourself so that you become familiar with the process and so that you can monitor progress on your own. Groups use Group NPI and Group EIN. Individuals use your personal NPI and Personal EIN.

Typically a credentialer will charge on average $100-200 per payer. They can also do your billing and charge on average 3%-8%

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Federal No Surprise Act: 

Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must Continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

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Ohio LACTS/ OHMAS:

Welcome to the OhioMHAS Licensure and Certification Tracking System (LACTS) Application web portal. LACTS allows you to electronically submit an initial or renewal application for an Adult Care Facility, an Adult Foster Home, a Residential Care Facility, a Community Mental Health Agency, and a Private Psychiatric Hospital; and review your licensure and or certification status, add sites, services, attach files, and update your facility and staffing information.

The LACTS User Guide is available to provide detailed instructions for managing license or certification applications for submission to Ohio Department of Mental Health and Addiction Services.

Liability Insurance Providers:

You should have one that covers the space you are working in and the one for liability. Liability may cover you or your practice. You should always carry your own liability insurance.

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OH Licensing Boards:

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Find your own insurance Self Employed Medical:

 

License Reciprocity:

Counseling Compact (Also contact your board)

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SAMHSA State Certification:

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.

ASAM Navigator

Practitioner Training

ASAM Levels of Care

 

Recovery Map: How it works

  • Inpatient Detox (3-10 days depending on acuity)

  • Inpatient (28 days)

  • Partial Hospitalization: PHP (2 weeks, individuals get to go home in the evenings but attend 6 days a week, 3 hours a day)

  • Intensive Outpatient: IOP (6 weeks, attend 3 days a week, 3 hours a day)

  • Sober Living (average length of stay is 6 months, continued programming)

  • Outpatient Treatment: Independent Counseling (Varies)

 

What you need to get started:

Information you will need on a continuous bases are below. You should have this information saved in a folder on your desktop. Also, do yourself a favor and start a spreadsheet of all the numbers you'll need to have access to in the moment.

 

Payers (Insurance Companies):

Apply to each of the payors here once you have all your affairs in order

​For Medicaid by state click this link

 

Register with the Exchanges: 

They actually process the billing claims for the insurance companies

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Payers:

A

Aetna

Phone (1-800-872-3862)

Member Services: 1-855-463-0933 (TTY: 711)

Member: Log-In/ Create a log in

Provider Services: 800-624-0756

Provider Credentialing: 800-353-1232

Provider Portal Medicaid Registration Form

Website Link: Aetna

Individual & Families: Individual & Family Health Insurance Plans & Coverage | Aetna

Providers Link Resources & Support for Health Care Providers | Aetna

Credentialing: https://cldaz.aetna.com/pocui/

Insurance Precertification: Precertification Lists

Insurance Verification:

Provider Manual: Provider manuals

Fee Schedule: Cost Estimator & Fee Schedules – Health Care Professionals | Aetna

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Aetna Better Health Of Ohio (Aetna Medicaid)

Phone: 855-364-0974 

Credentialing: 800-353-1232 #3

Claims & eligibility: 888-632-3862

Provider Portal: Dual Plan Medicaid/Medicare/ Medical: 855-364-0974

Provider Number Ohio Rise: 833-711-0773

Managed Care Entity (MCE) Out of Network managed care provider application

Website Link: Home | Aetna Better Health of Ohio

Providers Link:  For Providers | Aetna Better Health of Ohio

Claims: Claims | Aetna Better Health of Ohio

Clinical practice link: Clinical practice guidelines | Aetna Better Health of Ohio

Behavioral Health: Behavioral Health Redesign | Aetna Better Health of Ohio

Link: Provider Manual

Link: Provider Orientation kit

Link: Provider Application

Link: Application for Ohio Medicade Number

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Anthem Blue Cross Blue Shield

Phone: 888-650-5748

Credentialing: 844-912-1226

  • Central OH Madeline Corn 234-201-5121

Website Link: Anthem Blue Cross Blue Shield

Providers Link: Providers | Tools, Resources & More | Anthem.com

Provider Maintenance: Provider Maintenance | Anthem.com

Behavioral Health: Behavioral Health Provider Resources | Anthem.com

Claims: Provider Claims Submission | Anthem.com

Credentialing: Credentialing | Anthem.com

EAP: Employee Assistance Program (EAP): Providers

EAPClaims@Anthem.com

EAPProviderNetworks@Anthem.com

 

B

Beacon Health Options

Phone: 888-204-5581

Website Link: Beacon Health Options

Providers Link: Providers | Beacon Health Options

PCP Toolkit: PCP Toolkit

Link-  clinical tools page.

EAP: EAP | Beacon Health Options 

 

Buckeye Health Plan

Phone: 866-246-4356

Credentialing:  1-866-296-8731 #0

Website Link: Buckeye Health Plan

For Providers : Ohio Medicaid and Health Plans For Providers

Provider Resources: Ohio Provider Resources | Buckeye Health Plan

Behavioral Health: Behavioral Health

Become a provider: Become a Provider

Practice Link: Find a Doctor | Buckeye Health Plan


C

Caresource

Phone: 800-488-0134

Credentialing: 833-230-0210

Website Link: CareSource

Providers Link: Provider Overview | CareSource

Behavioral health : Behavioral Health | CareSource

Provider Manual: Provider Manual | CareSource

Practice Link: Find A Doctor/Provider

Claims: Claims | CareSource


ChampVA

Phone: 877-327-0022

Website Link: Veterans Affairs

Providers Link: Community Care (va.gov)

Claims: Community Care Home

Practice Link: Find VA Locations | Veterans Affairs

Contact:

EAP: Employee Assistance Program (EAP) Providers


 

Cigna (EverNorth)

Credentialing: 800-997-1654

Website Link: [Evernorth](https://www.evernorth.com/)

Care+ : Evernorth

Behavioral Health : Evernorth

Provider Link: Evernorth Provider

Resource Library: https://static.evernorth.com/

Practice Link: Evernorth Health Care Provider Directory

Contact:

EAP: https://static.evernorth.com/

 

CorpCare

Phone: 877-843-6036

Website Link:CorpCareEAP

For Providers: Providers – CorpCareEAP

EAP Tier One-Service Tier 1 – CorpCareEAP

Tier Two-Service Tier 2 – CorpCareEAP


 

F

First Health

Phone: 800-226-5116

Website Link MyFirstHealth.com

Provider Link: Healthfirst Provider Portal


 

H

Healthsmart

Phone: 304-556-1100

Website Link: HealthSmart

Provider link: Provider Center | HealthSmart

Credentialing : HealthSmart

Payor List: HealthSmart

Practice Link : HealthSmart Provider Lookup

Provider Manual: HealthSmart


 

Humana

Phone: 888-526-0997

Credentialing: 844-825-7898

Website Link: Humana

Provider: Humana for Healthcare Providers

Claims: Claims Resources for Providers - Humana

Credentialing Humana

Forms Humana

Practice Link: https://finder.humana.com

EAP: Employee Assistance Program (EAP) Information for Providers - Humana

           Employee Assistance Program (EAP) Provider Experience Summary.


 

M

Magellan

Email contact - Magellan Health

Website Link Magellan Health

Provider Link Magellan Health

 

Medical Mutual

Phone: 800-382-5729

Credentialing: 800-625-2583

Website Link Medical Mutual

Providers Link Healthcare Providers | Medical Mutual

Practice Link Medical Mutual Provider Search

Provider Manual: Medical Mutual

Credentialing: Provider Resources | Medical Mutual

 

Medicare- OH

Phone: 800-633-4227

Website Link: Medicare.gov

Practice Link: Find Healthcare Providers: Compare Care Near You | Medicare

Forms: Forms, help, & resources | Medicare

 

Medicaid- OH

Phone:  800-686-1516

Website Link: Ohio Medicaid

Resources: Ohio Medicaid

Provider Link: Ohio Medicaid

Fee schedule: Schedules and Rates

Mental Health Services: Mental Health

Programs: Ohio Medicaid

Enrollment: Enrollment & Support 

Contact: https://portal.ohmits.com/

 

Molina Healthcare of Ohio

Phone: (866) 449-6848

Credentialing: 855-322-4079

Website Link: Molina Healthcare 

Provider Link: Molina Provider Portal 

 

Multiplan/PHCS

Phone: 800-950-7040

Website Link: MultiPlan  

Providers Link: MultiPlan 

Links:



 

O

Ohio Health Choice

Phone: 800-554-0027;

Credentialing: 800-455-4460 #4

Website Link: Ohio Health Choice 

Resources: Provider Resources 

Provider Manual: Ohio Health Choice - Provider Manual  

Forms: Ohio Health Choice - Provider Forms 

Payor List: Ohio Health Choice - Payor List 

Faqs: Ohio Health Choice - FAQ 

Practice: Ohio Health Choice - Provider Search 

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Optum VA:  

VACCN Provider Services 844-839-6108

Optum Prover Express

Provider Express Onboarding

Clinical Resources

Fee Schedule (take 25% off non-facility price for clinical)

 

Oscar

Phone: 855-672-2788

Website Link: Oscar Insurance 

Providers Link: A health insurance partner that makes your job easier. 

Resources: https://provider.hioscar.com/resources/arkansas/Overview/


 

Oxford

Website Link: Oxford Health Plans 

Provider Link: UHCprovider.com 

Practice Link: Home [provider.liveandworkwell.com] 

Claims and Payments: UHCprovider.com 

Important Links 


 

P

Paramount Advantage

Phone: 419-887-2564

Website Link Paramount Health Care 

Resources Paramount Health Care 


T

Tricare East ( Humana Military)

Phone: (800) 444-5445

Website Link Humana Military 

Provider Link TRICARE East providers 

Resources Humana Military 

Behavioral Health Behavioral health information for TRICARE East providers 


U

United Health Care

Credentialing: (800)711-4555

Provider Line: (877) 614-0484

Phone View provider contact information by state

Website Link UnitedHealthcare 

Providers link UHCprovider.com 

Claims UHCprovider.com 

EAP Employee Assistance Program | UnitedHealthcare 

Resources UHCprovider.com 

 

V

VA/CNN (Optum)

Phone: 800-888-2998

Website Link Optum

Provider Link Solutions for Health Systems

Credentialing Contact us

EAP Optum

Columbus
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