This article is co-authored by Headway
Credentialing is the process of joining an insurance plan’s network so you can serve clients covered by their health plans.
Also called “paneling” or becoming “in-network,” credentialing has the potential to make your services accessible to more clients and help you fill out your caseload.
Here are the steps you need to take to get your private practice credentialed, from choosing insurance plans to understanding timelines.
You can save time by joining the network of providers at Headway, where a practice consultant can help you quickly become credentialed with every available plan, in every state you practice, all at once.
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Quick review: Why is credentialing important?
Before an insurer can bring you in network—and send its members to your practice—it needs to confirm you’re licensed and trained to provide care.
But it’s a two-way street. . During the process, you get a chance to review how the insurance plan does business, including their fee schedule.
The schedule tells you how much you’ll be reimbursed by the insurer for the services you provide insured clients.
So getting credentialed is a chance for both you and the insurer to learn about one another, and decide whether a professional relationship would be mutually beneficial.
Choose insurance providers
Each insurance company is different. When considering which company you’d like to be credentialed with, check out online reviews by in-network providers or interview other therapists whom you know to have been credentialed with them.
As you do, ask:
- How quickly does the insurer pay out providers after billing?
- Are they reliable? Have providers faced any difficulty being paid?
- What does their fee schedule look like? For a comparison of insurers’ average reimbursement rates for therapists, download Heard’s 2024 Financial State of Private Practice Report.
- What is the process for clients with coverage being referred to in-network therapists?
- What tools do clients with coverage have at their disposal for finding local in-network providers (eg. apps, online dashboards)?
- How reliable and helpful is the insurer when it comes to customer support on your end? How easy or difficult is it to talk to a human being when you have a question?
- What is the process of billing the insurance company? Do they offer any tools (eg. apps, online dashboards) for in-network therapists?
- Are there any particular demographics the insurer especially serves? (e.g. Armed Forces members, federal employees, the employees of major employers where you live, Spanish-speaking clients, etc.)
On-time payments and reliable support are key to growing your insurance practice. When you partner with a service like Headway, you can avoid dealing with insurance plans directly, and receive customized support and twice-monthly payments for the sessions you hold—even when a claim is delayed.
Finding out how to apply
Some insurers’ websites make it easy to find information on applying and becoming credentialed. Others do not. As a shortcut to finding insurers’ provider portals and application guides, try these Google searches:
- [INSURER NAME] join network
- [INSURER NAME] mental health credential
- [INSURER NAME] provider application
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Prepare your information
Unless you use a service like Headway, you must complete a separate application for each insurer you’d like to be credentialed by.
However, these applications—for the most part—all ask for the same information.
Before you start filling out applications, gather all of the following in advance:
- Your name and home address
- Your practice’s name and address
- Your license information
- Your National Provider Identifier (NPI) number
- The healthcare taxonomy code for your practice
- A copy of your CV
- Proof you’re insured for malpractice (professional liability insurance),
- Proof of liability insurance covering rental property (if applicable)
- Paperwork covering any advanced training you’ve received
In addition to each application to an insurance company, you’ll need to prepare a single Council of Affordable Quality Healthcare (CAQH) application.
Complete a CAQH application
If it’s your first time applying to be credentialed, you’ll need to complete a CAQH application. Once you register with CAQH, you won’t need to do so again, although you must periodically reattest the information you provided.
What is CAQH?
CAQH works like a giant database of provider information that insurance companies and credentialing services pay to access. You, the provider, do not pay to register.
Once you’ve registered, you’ll receive a CAQH ID. It’s a registration number insurance companies can use to look up your CAQH information. If you think you may already be registered with CAQH, but don’t remember your ID, you can request to have it sent by email.
When do you apply for CAQH?
You apply for CAQH after completing and submitting an application to be credentialed with an insurance company.
The insurer will contact you with information for signing into CAQH and completing your registration. Once you register, the insurance company will proceed with the next steps in your application process.
What information do you need to apply for CAQH?
Before beginning your CAQH application, make sure you have the following information on hand:
- Your NPI number
- Your license to practice therapy
- Your up-to-date CV
- Your malpractice insurance certificate
- Copies of your diplomas
How do you apply for CAQH?
Once you’ve received registration information from an insurer, you’ll fill out a CAQH ProView application online. This will create a CAQH ProView account for you.
When do you reattest your CAQH?
You’re required to reattest your CAQH information every 120 days. If you don’t keep your CAQH up to date, it could affect your ability to bill insurers. To reattest, sign in to your CAQH ProView account.
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Go through the filing and approval process
Once you file your application with each insurer, the wheels start turning. Certain steps will be followed internally by the insurance company as they consider your application. You, in turn, may be asked to provide supporting information before you’re invited to join the insurer’s network.
Here are the typical steps to the application process.
- Application. You fill out your application and submit it to the insurer. This is the bulk of the work you’ll have to do to apply.
- CAQH. If you don’t yet have a CAQH ID, the insurer will contact you with the information you need to get one. Once you’ve completed your CAQH application, the rest of the filing and approval process proceeds as normal.
- Queries. If the insurer needs any additional information about you or your practice, they’ll contact you before moving on to the next step. Get back to them with any missing information ASAP so you don’t lose your place in the queue of applicants.
- Proposed fee schedule. If you meet the basic requirements for joining the insurer’s network, they’ll send you a proposed fee schedule. It’s a breakdown of how much you can expect to be reimbursed for different services when you bill the insurer.
- Credentialing committee review. Once you’ve settled on a fee schedule—whether it’s one the insurer initially proposed, or another one that you negotiate—your application will be reviewed by a credentialing committee internal to the insurance company. They’ll consider your qualifications as a therapist as well as their own needs as a company: Their need for more therapists in their network, the needs of their customers, and their need to make a profit.
- Approval process. If you’re approved, the insurer will begin the process of adding you to the network. This mostly consists of paperwork you’re never privy to, save the contract offer.
- Contract offer. The insurer will send you a contract to sign so you can join their network. Carefully review this. Make sure the reimbursements specified by the contract match your expectations. Also, check for everyday errors or typos; a misspelled name or incorrect street address can lead to delays. If you have a lawyer, you may ask them to help you review the contents of the contract.
- Contract signing. Once you’re happy with the contract you’ve been offered, sign it and submit it to the insurer. Keep a copy for your records.
Follow up (when? and how?)
Therapists who have gone through the detailed credentialing process will recommend you follow up with an insurance company after you submit your application.
Phoning the insurer and checking on the status of your application helps to make sure everything is on track, that your application hasn’t been delayed for some reason, and that you haven’t missed any requests for additional info the insurer may have sent you.
Following up is such a common practice, in fact, that some insurers designate specific amounts of time that must elapse before you contact them about your application. If an insurer has such guidelines, respect them. Breaking the rules won’t help the status of your application.
If they don’t specify a particular span of time, follow up after three to four weeks. And be patient: Insurance companies are huge organizations, and they’re constantly processing new applicants.
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How long does it take to get credentialed by an insurer?
The amount of time it takes to move from application to contract varies. It depends on your location, the services you provide, and the amount of applicants the insurer is currently processing.
Generally speaking, you can expect it to take 90 to 120 days from the day you first submit your application before you begin operating as an in-network provider.
If you want to start seeing insurance patients sooner, partner with Headway to handle your credentialing instead. Most applications through Headway take 30 days or less.
What if I need to bill clients in multiple states?
If you are licensed as a therapist in multiple states, and you’d like to be able to bill insurance companies in all of those states, you’ll most likely need to complete a separate application for each license you hold.
So, for example, if you held a therapist's license in California and another in Arizona, and you wanted to bill insurance companies in both states, you’d complete a California application for your California license and an Arizona application for your Arizona license.
That’s the general rule. Individual insurance companies may differ in how they work with multi-state therapists. Contact the insurance company directly for more guidance.
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Headway is a free service that makes it easier and more profitable for therapists and psychiatrists to accept insurance. From built-in client documentation, and scheduling to free CEUs and dedicated support, Headway provides the foundation you need to grow your insurance practice. Talk to a practice consultant to learn more.
This post is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult their own attorney, business advisor, or tax advisor with respect to matters referenced in this post.
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