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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.

Our Partners 
For
Credentialing & Billing

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Phone: (281) 994- 7020
Email: support@rcmexperths.com
Website: www.rcmexperths.com
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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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Clinician Information
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Do you possess a DEA-X waiver fo OUD Treatmet Services?
Are you Child Adolescent Board Certified?
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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

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

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.

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

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

 

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

 

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

Billing e-Guide

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

Mental Health Resources Map

Belongly link 

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%

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.

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.