How To Handle Insurance Paneling for Your Employees
When you’re starting a new private practice, you’ll need to consider insurance paneling or credentialing and whether it fits your business model. Insurance paneling has many benefits, such as built-in referrals from insurance companies, casting a wider net for clients seeking affordable mental health care, and improving your reputation as a clinician.
Unfortunately, insurance paneling is a complicated, time-consuming process that reduces privacy for you and your clients and can delay your payments. Insurance paneling can feel like a daunting task, especially if you’re busy setting up a private practice. Many therapists opt to work with only private pay clients, so they don’t have to deal with the credentialing process.
If you’re curious about insurance paneling and how it works with your private practice business model, continue reading. We’ll discuss the ins and outs of insurance paneling so you can make the best decision for your business.
What Does It Mean To Be Paneled With Insurance Companies?
Insurance paneling or credentialing is a collection of healthcare providers and mental health clinicians an insurance company will pay for mental health services for their customers. It’s the difference between being an in-network or out-of-network provider.
When you are an in-network provider, the insurance company streamlines the payment process and recommends you to their customers. Being an in-network provider also makes mental health care more affordable. Each insurance company has a different application and credentialing process, so you’ll need to submit separate applications for each insurance company you want to work with.
The application process for one insurance company can take about ten total hours to complete. You’ll have to wait 60-120 days for provider credentialing if your application is complete the first time. That time frame is longer if the insurance company asks you for additional information.
Since insurance paneling for therapists and group practices is time-consuming, many mental health providers hire a credentialing service to handle the paperwork for them. Expert credentialers are familiar with the credentialing application process and can move things along more quickly than individuals. They can also advocate on your behalf with the insurance company.
Medical insurance companies will close their insurance panels for mental health counselors once they get a certain number of providers. When that happens, you have to move on to another insurance company for credentialing or wait until a spot opens. Often providers have an easier time credentialing with smaller insurance companies than with the larger ones like Aetna, Blue Cross, and Cigna.
How to Get Paneled With Insurance
While each insurance company has a different multi-step process for paneling, having a system in place for attacking insurance paneling can ensure you don’t miss any vital information that can cause you to lose time. When starting a private practice, your time is valuable. Here are a few action steps to help you stay organized.
Decide on the Best Insurance Panels for Group Practice or Private Practice
Making a decision about the best insurance panels for therapists depends on your goals and mission and whether you run a group or private practice.
Every insurance company has different reimbursement rates, requirements for credentialing, and restrictions for practicing. Otherwise, you may waste time applying for paneling that doesn’t fit your business model. You can ask other mental health professionals in your area for recommendations on the best companies to work with, look at the insurance company’s website, or call the companies directly. Some questions to ask include:
- Payment reliability and speed: Are payments on time and without added hassle? Is their payment schedule and time frame competitive?
- Additional services: Some insurers offer other benefits like marketing tools.
- Provider support: How easy is it to get ahold of support from providers?
Once you decide which insurance companies to panel with, you’ll need to look at their requirements for credentialing.
Collect Your Information for Credentialing
While each insurance company has a different process for credentialing, most will require similar information. Having all of this information in one place will speed up the application process. Consider making a file folder with all of this informations or even scanning documents and saving them in a single electronic folder for easy access. If you’re starting a group practice, have each of your employees keep a similar system in place. Items to collect include:
- Your National Provider Identifier (NPI number)
- Licensure information
- Taxonomy code
- An updated resume
- Proof of malpractice insurance
- Proof of liability insurance if renting office space
- Advanced training or credentialing paperwork
- Any board certification documents
Fill out the CAQH
CAQH stands for Council for Affordable Quality Healthcare. It’s a one-time process designed to create a standardized process for insurance credentialing. However, you can apply for a CAQH via invitation only, so you’ll need to apply with an insurance company first. The insurer will give you a CAQH number to use for your application.
A CAQH profile streamlines the credentialing process when applying for multiple insurance companies. But, errors on the CAQH application can cause significant processing time delays, so triple-check that it’s filled correctly. You’ll also need to re-attest to the CAQH every four months, so keep the information handy to avoid delays in insurance paneling.
Submit Your Application and Follow Up
Keep a copy of everything you submit to insurance companies. There may be as many as ten people handling your paperwork at the insurance company, so it’s easy for pieces to get lost.
Follow up about 45 days after submitting your application to check its progress. If you’re denied for any reason, be sure to let the insurance company know of any changes in your business or certifications. Update them if you offer expanded hours, multilingual staff, or experience with special populations to increase your chances of approval.
Review Insurers Requirements After Approval
Once approved through an insurance company, review the requirements for providers and be sure to follow them to ensure on-time payments and continued credentialing. You’ll want to follow the rules for medical billing documentation, claim processes, fee schedules, current procedural terminology (CPT) codes, and appeals processes. Ensure anyone on your team who submits to insurance companies knows and follows these guidelines.
Group vs. Individual Credentialing
When scaling your practice, you may have questions about group vs. individual credentialing. There are benefits and risks associated with both individual and group credentialing, but what you decide for your business will depend on your goals and business model. Some insurance companies allow practitioners to credential individually but connect with a group using a practice’s Tax ID number. This is a compromise between individual and group credentialing.
When clinicians have individual credentialing with different insurance companies, it stays with them regardless of what practice they work with or if they move around. As a group practice owner, this means you may hire people who are already credentialed. If they aren’t, you’ll need to decide if you pay for the credentialing process for them or if that’s their responsibility.
When a group submits an insurance paneling application, every group member must meet the requirements as an individual. As a group practice owner, if one group member leaves, they don’t take the credentialing with them. Group credentialing provides some security because you aren’t paying for credentialing for employees who leave and take it with them.
What Information Is Needed for You To Complete a Group Application for Credentialing?
Since every individual practitioner has to meet the exact requirements of individual credentialing with a group application, you’ll need the same information detailed above. However, when credentialing as a group, you’ll have a practice Tax ID number instead of individual Tax IDs for each clinician. Since you’ll also need to re-attest regularly, storing all of your credentialing information for easy access is vital.
Get Support When Making Insurance Paneling Decisions
Since insurance paneling comes with many benefits like increased client reach, and a few complications, it’s essential to evaluate whether credentialing fits your business model before starting the process. Sinking time into an insurance paneling process when it doesn’t match the needs of your business wastes money and resources.
When you’re starting or scaling your private practice, decision-making can be overwhelming. You have to decide between private or group practice, find a location, set up payroll and marketing, hire therapists and administrative staff, not to mention handle your caseload. Hiring a private practice coach or consultant can help you make the right decisions the first time, avoiding lost time and money.
Soribel Martinez, LCSW, is a psychotherapist and sex coach who created SMPsychotherapy services and scaled it into a practice with ______ therapists who serve over _____ clients. She’s offering coaching services to mental health practitioners ready to grow their practice and create the independent life they crave.Working with Soribel will ensure you have the necessary support and accountability to make the right decisions for your business. Book your FREE Business Consultation Call today to learn more about Soribel’s business coaching services. She’ll ask questions about your current business, your goals for scaling your practice and provide her recommendations for your next steps.