Behavioral Health Credentialing: Requirements, Process, and Best Practices

What Makes Behavioral Health Credentialing Different?

Behavioral health credentialing follows the same general principles as medical credentialing, but with important differences that can trip up providers who aren't prepared. The most significant difference is the behavioral health carve-out structure used by many major insurance companies.

In a carve-out arrangement, the insurance company contracts with a separate behavioral health organization to manage mental health and substance abuse benefits. This means behavioral health providers often credential through a different entity than medical providers, even when they're joining the same insurance plan.

Understanding Behavioral Health Carve-Outs

Here's how major payers structure their behavioral health credentialing:

UnitedHealthcare / Optum

UnitedHealthcare manages behavioral health through Optum Behavioral Health. Behavioral health providers typically credential through Optum's provider portal rather than through UnitedHealthcare directly. The process uses CAQH ProView data but has its own application requirements.

Cigna / Evernorth

Cigna's behavioral health benefits are managed by Evernorth Behavioral Health (formerly Cigna Behavioral Health). Credentialing applications go through Evernorth's provider portal. Evernorth has specific documentation requirements that differ from Cigna's medical credentialing.

Blue Cross Blue Shield / Carelon

Many BCBS plans contract with Carelon Behavioral Health (formerly Beacon Health Options) to manage behavioral health. However, this varies by state, as BCBS operates as independent companies in different regions. Some BCBS plans handle behavioral health credentialing in-house.

Aetna

Aetna generally handles behavioral health credentialing through its own credentialing department rather than using a carve-out. This can simplify the process, but Aetna has specific requirements for behavioral health providers that differ from their medical provider credentialing.