How to Get Credentialed with Insurance Companies: A Step-by-Step Guide
By Behavioral Health Contracting
Why Get Credentialed with Insurance Companies?
Getting credentialed with insurance companies is how healthcare providers become "in-network" and gain access to insured patients. For most practices, this is the foundation of a sustainable business model.
Without credentialing, you're limited to cash-pay patients or submitting claims as an out-of-network provider, which means lower reimbursements and higher costs for your patients. In behavioral health especially, where patients often need ongoing treatment, affordability through insurance coverage is a major factor in patient retention.
Before You Start: Prerequisites
Before applying for credentialing with any insurance company, make sure you have these essentials in place:
An active, unrestricted state license in the state(s) where you'll practice.
A National Provider Identifier (NPI) number. Apply at nppes.cms.hhs.gov if you don't have one.
Professional liability insurance (malpractice coverage) with adequate limits, typically $1M/$3M.
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A Tax ID number (EIN for organizations, SSN for solo practitioners).
A physical practice address that meets payer requirements (some payers don't accept virtual-only addresses).
Step 1: Determine Which Insurance Panels to Join
Not all insurance panels are created equal. Prioritize based on:
Patient demand: Which insurances do patients in your area use most? Check local demographics and ask colleagues.
Reimbursement rates: Some payers pay significantly more than others for the same services.
Panel availability: Some panels are closed in certain geographic areas. Call the payer's provider relations department to check.
Administrative burden: Some payers are known for complex authorization requirements and slow payments.
For behavioral health providers, the most common payers to credential with include UnitedHealthcare/Optum, Aetna, Cigna/Evernorth, Anthem Blue Cross Blue Shield, Humana, and your state's Medicaid managed care organizations.
Step 2: Set Up Your CAQH ProView Profile
CAQH ProView is the industry-standard credentialing database. Nearly every major payer pulls from CAQH, so a complete and accurate profile is essential.
To set up your CAQH profile:
Register at proview.caqh.org and get your CAQH provider ID.
Complete every section of the application, including practice locations, education, training, licenses, and certifications.
Authorize insurance companies to access your profile by adding their names to the authorization list.
Attest your profile to confirm all information is current.
Important: CAQH requires re-attestation every 120 days. Set a calendar reminder to avoid lapses.
Step 3: Submit Credentialing Applications
With your CAQH profile complete, you can begin submitting applications to individual payers. The process varies by company:
Online Portal Applications
Many large payers accept applications through their provider portals. UnitedHealthcare, Aetna, and Cigna all offer online application systems. Create an account, complete the application form, and submit electronically.
Paper Applications
Some payers, particularly smaller regional plans and Medicaid managed care organizations, may still require paper applications. Download forms from the payer's website or request them from the provider relations department.
CAQH-Direct Applications
Some payers will pull your information directly from CAQH after you authorize them. In these cases, you may not need to submit a separate application beyond adding the payer to your CAQH authorization list.
Step 4: Follow Up Regularly
This is where most providers fail. After submitting applications, you must actively follow up. Insurance companies process thousands of applications and yours can easily get lost.
Call the payer's provider relations or credentialing department 2 weeks after submission to confirm receipt.
Follow up every 2-3 weeks after that to check status.
Document every call: date, time, representative name, reference number, and what was discussed.
Respond to any requests for additional information within 48 hours.
Step 5: Review and Negotiate Your Contract
Once approved, you'll receive a provider agreement with a fee schedule outlining your reimbursement rates for each CPT code. This is where many providers make a costly mistake: they sign without reviewing the rates.
Key things to review in your contract:
Reimbursement rates for your most commonly billed CPT codes (90837, 90834, 90847 for behavioral health).
Timely filing requirements (how long you have to submit claims).
Authorization requirements for different service types.
Termination clauses and notice periods.
Rate escalation clauses (annual increases).
Panel exclusivity requirements.
Don't accept the first offer. Insurance reimbursement rates are almost always negotiable. Providers who negotiate typically secure 10-30% higher rates than the initial offer. A contracting specialist who understands behavioral health reimbursement benchmarks can be invaluable here.
Step 6: Complete Payer Enrollment
After signing your contract, there's often an additional enrollment step to activate your participation. This may include:
Your effective date (the date you can begin seeing patients under the contract) is usually tied to your credentialing approval date, not when you signed the contract. Some payers will backdate claims to the approval date, so clarify this.
How to Speed Up the Credentialing Process
Credentialing typically takes 60-120 days, but you can minimize delays:
Submit all applications simultaneously rather than one at a time.
Ensure your CAQH profile is 100% complete before applying anywhere.
Respond to payer requests within 24-48 hours.
Keep all licenses, certifications, and insurance current, nothing kills a credentialing application faster than an expired document.
Consider working with a credentialing service that has established relationships with payer credentialing departments.
What If a Panel Is Closed?
If a payer tells you their panel is closed in your area, you still have options:
Ask about waitlists and get on them.
Check if they have open panels for specific specialties or underserved populations.
Apply anyway, panels can open without notice and having your application on file means faster processing.
Look into the payer's Medicaid managed care plans, which often have more availability than commercial plans.
Contact a contracting firm that has relationships with network development teams at major payers.
Next Steps
Getting credentialed with insurance companies is a significant time investment, but it's one of the highest-return activities for building a behavioral health practice. If you want to streamline the process and ensure you're getting the best possible reimbursement rates, Behavioral Health Contracting can help.
We handle the entire credentialing and contracting process for behavioral health providers across all 50 states. Contact us for a free consultation to discuss your credentialing needs.
