What is Credentialing?

Credentialing is a critical factor in the insurance process for mental health therapists. Mental health therapy can be expensive and many people cannot afford it without insurance coverage. Insurance companies need to know that the therapist they are working with has been approved by the state as meeting their requirements, which is where credentialing comes into play. This article will provide an overview of what you need to know about credentialing as a mental health therapist and how to get started on your own credentialing process!

The first step in the credentialing process is to determine what panels you want to join and if you’re eligible. There are a variety of panels that one can join. Commercial insurance panels such as Aetna and BCBS and Government sponsored plans (e.g. Medicare, Medicaid and Tricare) all have their own credentialing requirements. Additionally, some providers choose to accept Employee Assistance Plans.

Next, most insurance companies require that the provider obtains a CAQH and NPPES profile and number. These profiles may have been set up for you by a previous employer but these profiles belong to the provider. The provider is issued one CAQH and one NPPES number for the life of their career.

Once you have determined that you meet the criterion to join the network, the next step is to gather all of the required documentation. This can include your resume, license, malpractice insurance, W9, and more. Check out our credentialing 101 checklist for the list of documents needed to start the credentialing process. The specific requirements vary by state and insurance panel, so it is important to check with your state’s licensing board and each insurance panel’s website for more information.

After you have gathered all of the necessary documentation, you will need to submit an application to each insurance panel following their credentialing guidelines. Once your application has been reviewed it undergoes two processes. Most people think of the credentialing process as one-step when in fact, it is two for most providers.

Step one includes a verification of your credentials. This part of the process is to ensure that you are an eligible provider. For example, there are some panels that only credential fully licensed providers while other panels will credential provisionally licensed (require supervision in order to practice).


Step two is the contracting phase. For many panels, this part of the process generally takes the most time. This step includes contract generation, fee schedule development and loading the provider, practice and billable codes into the claims submission system.

The credentialing process can be time-consuming, so it’s important to be prepared. The entire process usually takes between 90-180 days but could take longer depending on the insurance panel.

One of the most common challenges during the credentialing process is obtaining all of the required documentation. Many of the required documents need to be obtained from other organizations, which can add significant time to the process. Another challenge that providers face is getting everything submitted in a timely manner, submitting late or incomplete applications can significantly delay the credentialing process. Lastly, insurance panels aren’t known for being organized or responsive. It often requires numerous phone calls, emails and faxes in order to get status updates or answers from the insurance representatives.

One way to streamline your credentialing journey is by using a credentialing specialist. A credentialing specialist can help you obtain the required documentation, submit your application and follow-up with insurance representatives on your behalf.

If you decide to tackle the credentialing process on your own, here are a few tips:

– Start early: The sooner you start, the better. There’s a lot of paperwork involved and it can take several months to complete the process.

– Stay organized: Keep all of your documents in one place so that you can easily find them when needed.

– Follow up: Don’t be afraid to follow up with insurance representatives if you haven’t heard back from them in a while. It’s often necessary in order to move forward in the process.

-Document: Document all phone calls, reference numbers, names and outcomes/actions 

The credentialing process can be long and challenging, but hopefully, these tips will help make the journey a little smoother. Mental health providers play an important role in our society and it is vital that they have the necessary credentials to provide quality care for their patients.

If you are a mental health provider interested in learning more about credentialing, check out our free webinar on the topic. In this webinar, we discuss everything you need to know about insurance credentialing for mental health therapists. Click here to register for the Insurance 101 webinar.

If you’d like our team to handle the credentialing process for you, please complete this form to request a quote for credentialing services.

Do you want us to train your team? We have 2 options to train you or your team to handle your credentialing in house:

Welcome To Mastering Insurance

Let us train you or your team on how to navigate credentialing in billing. We have course for both in network or out of network behavioral health providers.

Credentialing 101 Course

Self-paced course where we walk you (or your admin) through the nuts and bolts of Credentialing

Admin Academy

This is a done with you option. We have the self-pace course, monthly trainings and LIVE support through our facebook community and weekly office hours.

You also get access to the Billing 101 course, Documentation course, Audit proofing your practice and more.