Five Keys to Credentialing for Behavioral Health Providers

The process of credentialing is fundamental in ensuring the quality, reliability, and legitimacy of healthcare providers. In the realm of behavioral health, where the impact of care is deeply personal and intricate, credentialing holds immense significance. It serves as a cornerstone for guaranteeing that those in need receive effective and safe treatments. Let's explore the five pivotal keys to credentialing in behavioral health.

1. CAQH Profile Data: Behavioral health providers must create a CAQH account and fill out the required sections. Providers should also upload important documents like current professional liability insurance, professional licenses, and W-9s or other applicable tax forms. One of the required numbers for every CAQH profile is the provider's individual and if applicable group NPI. The National Provider Identifier is required for both individual providers and group practices. The provider's CAQH profile helps insurance companies validate and verify the provider's details including personal information, professional information (including specialties), education, employment history, and ... The information providers enter in their CAQH profile is used for credentialing, directory management, claims, and other functions. The provider also designates who has access to their CAQH profile information.
2. Additional Documentation is Required: Depending on the insurance company, behavioral health providers may need to upload additional documentation. Typical insurance paneling applications require a copy of the provider's current professional liability insurance policy (including policy number and effective dates), copies of professional licenses, and a physically signed W-9 (which should be re-signed and uploaded to CAQH annually). If a provider wants to accept Medicaid, two additional documents may be required. In the state of Utah for example, providers must submit a physically signed agreement and an access agreement form for anyone else needing to access your Medicaid claims. For example, if you contract out billing services, that biller needs access to your Utah state Medicaid account to manage claims, rejections, and payments.
3. Finding, Filling Out, and Submitting Behavioral Health Credentialing Applications: Every healthcare insurance provider is different and maintains different applications, processes, and submission requirements. Some applications are online and easy to find, fill out, and submit. However, most applications are not all that easy to find on a company's website. Some applications are simple and straightforward, but some are a little more complicated. Some applications require a signature, some don't. Once a behavioral health provider has decided which insurance plans to apply for paneling, it might be a smarter move to hire a credentialing specialist.
4. The Importance of Following Up: Credentialing applications rarely move forward without any hitches. A follow up call or email is essential in ensuring a provider's application was received and completed correctly. Paneling with insurance companies can take anywhere from three to six months. Providers that fail to follow up, can plan on the full six month timeframe.
5. Ongoing Monitoring and Quality Improvement: Credentialing is not a one-time process; it requires continuous monitoring and quality improvement. Providers must keep their profiles current to ensure accuracy in directory listings (think of these as lead forms), claims, and reimbursements.

The significance of these five keys to credentialing in behavioral health cannot be overstated. Patients seeking mental health or substance abuse treatment rely on the expertise and reliability of their providers. Credentialing acts as a safeguard, assuring patients and healthcare organizations that they are entrusting their well-being to competent and ethical professionals.

In conclusion, credentialing in behavioral health is a multifaceted process that demands attention to detail, adherence

to standards, and a commitment to ongoing improvement. By upholding these five keys to credentialing, the behavioral health landscape can continue to provide quality care, foster trust, and prioritize the well-being of those seeking assistance.