Wiki Provider Credentialing for Behavioral Health/Mental Health

[smeeks31]

I am a coder who is dabbing in credentialing for behavioral health/mental health. I have some concerns with credentialing with Medicaid and other Commercial insurance. Do I have to wait for Medicaid to credential with other insurance companies? Changing the group to an organization. I work in a FQHC facility and these are things are being brought to my work list at this point and time. Thank you for any information, training, resources or how can I take a course for credentialing providers in general.

 

[deyoung]

You shouldn't have to wait. You should be able to submit all your app's at the same time. Usually the various insurers credentialing committees meet at different times so you'll want to get them in as soon as you can.

I know there is a certification you an get for credentialing through another organization but I can't remember it...I've seen credentialing specialists in the past have it after their name...maybe try google.

 

[jennamiller]

Behavioral Health Credentialing

Go to the NAMSS website for the certification info. There are some requirements. I have medical staff and payer credentialing experience. Currently work for a behavioral health organization and we do credentialing for 2 states as we have an office in a border state. Never a dull moment in credentialing!

P.S. Find a really good contact at all your payers. They will be very valuable.

 

[seastarr27]

Caqh

Hi. I myself work in a Behavioral Health office. When credentialing it is imperative that they have their CAQH updated and open to allow for insurance companies to view. This is a what a lot of them use in the credentialing and contracting of providers. Also credentialing is only the part where they verify the providers information, once that is completed then it goes into the contracting stage. Keep on top of these insurance companies. Some can be a pain but if you have not heard anything in response to the providers application being submitted call, call, call until you are told they have it. Also print/screen shot every online application you submit. Document when and how it was sent. Also document when, who, how you spoke with someone. This will help should you come across any contracting effective date issues. Some insurance companies will do a retroactive date some do not. Also, if a provider is already in-network with an insurance company and is changing practices they may only have to do a provider update form instead of the whole process all over again. So call and find out first. Also find out who your local contact is for each insurance company. They are generally the person that can answer any questions you have. I hope this helps.