Comprehensive guide to contracting with major insurance payers for behavioral health facilities. Access detailed information on credentialing requirements, reimbursement structures, and network opportunities.
2025 Updates: Enhanced virtual PHP/IOP coverage across major payers, new value-based contracting opportunities with Anthem's Behavioral Health Provider Collaboration program, and streamlined credentialing through Availity for multiple payers. Most payers now offer single case agreements (SCAs) for out-of-network facilities.
Major insurance companies with nationwide presence and extensive behavioral health networks. These payers typically offer the highest patient volume and most comprehensive coverage.
(UHC)
UnitedHealthcare is the largest health insurance company in the United States, serving over 50 million members nationwide. As part of UnitedHealth Group, they offer comprehensive behavioral health coverage through their Optum subsidiary, creating integrated physical and mental health solutions.
(Aetna)
Aetna, a CVS Health company, is one of the nation's leading diversified health care benefits companies, serving approximately 39 million members. The integration with CVS Health creates unique opportunities for integrated behavioral health delivery through retail health locations.
(Cigna)
Cigna is a global health service company with over 190 million customer relationships worldwide. Through their Evernorth division, they offer comprehensive behavioral health services with a focus on whole-person health and integrated care delivery.
(Centene)
Centene Corporation is a leading multi-national healthcare enterprise serving over 28 million members through government-sponsored programs including Medicaid, Medicare, and Health Insurance Marketplace. They operate under various local brand names including Ambetter, WellCare, Fidelis Care, Health Net, and numerous state-specific health plans. Following the acquisition of Magellan Health in 2022, Centene has expanded its behavioral health capabilities significantly.
(Humana)
Humana is a leading health and well-being company focused primarily on Medicare Advantage and employer group coverage. With a strong presence in senior care, Humana emphasizes integrated care delivery and behavioral health services for aging populations.
BCBS licensees operating independently across different states with strong regional presence and comprehensive behavioral health coverage.
(Anthem BCBS)
Anthem, Inc. (now Elevance Health) is one of the largest Blue Cross Blue Shield licensees, serving over 47 million members across multiple states. They offer comprehensive behavioral health benefits through their extensive network and integrated care models, managed through Carelon Behavioral Health.
(BCBS TX)
Blue Cross Blue Shield of Texas, a division of Health Care Service Corporation, is the largest health insurer in Texas with over 6 million members. They command 44% of the commercial insurance market and provide comprehensive behavioral health coverage across the state.
(Florida Blue)
Florida Blue (Blue Cross Blue Shield of Florida) is the state's largest health insurer, serving over 5 million members. As part of GuideWell, they command approximately 40% of Florida's commercial insurance market with comprehensive statewide coverage.
(Regence)
Regence BlueCross BlueShield serves over 2.4 million members across four western states. Part of Cambia Health Solutions, Regence focuses on transforming health care with innovative solutions and comprehensive coverage.
Health systems that combine insurance coverage with direct care delivery, often offering unique contracting opportunities and integrated care models.
(KP)
Kaiser Permanente is one of the nation's largest not-for-profit health plans, serving 12.6 million members. As an integrated health system, Kaiser Permanente combines health coverage with care delivery through Kaiser Foundation Health Plans and Hospitals.
(HealthPartners)
HealthPartners is the largest consumer-governed nonprofit health care organization in the nation, serving 1.8 million members. As an integrated health system, they operate both health plans and care delivery through clinics and hospitals, including specialized behavioral health facilities.
Insurance companies with strong presence in specific geographic regions, often with competitive rates and local market expertise.
(Molina)
Molina Healthcare specializes in government-sponsored healthcare programs, serving over 5.7 million members through Medicaid, Medicare, and Health Insurance Marketplace plans. They focus on providing quality care to financially vulnerable families and individuals, with a strong emphasis on behavioral health integration.
(CareSource)
CareSource is one of the nation's largest Medicaid managed care plans, serving over 2 million members. As a nonprofit organization founded in 1989, they focus on providing accessible healthcare to underserved populations with emphasis on integrated care and community health. They offer Medicaid, Medicare, and Health Insurance Marketplace products.
(Medica)
Medica is a nonprofit health plan serving over 1.5 million members across the Upper Midwest. They focus on affordable healthcare solutions with strong presence in both commercial and government programs.
(Oscar)
Oscar Health is a technology-driven health insurance company focused on individual and small group markets. Known for their user-friendly digital platform and emphasis on member engagement, they serve over 1.6 million members with a modern approach to healthcare. Oscar operates in 504 markets across 18 states as of 2025.
Specialized insurance programs serving military members, veterans, and their families with specific credentialing and contracting requirements.
(TRICARE East)
TRICARE East Region, managed by Humana Military, provides comprehensive health coverage to military service members, retirees, and their families across the eastern United States. The program serves over 5 million beneficiaries with a focus on maintaining military readiness. Humana Military continues as the contractor through the new T-5 contract beginning January 1, 2025.
(TRICARE West)
TRICARE West Region, managed by TriWest Healthcare Alliance as of January 1, 2025, serves military members, retirees, and families across the western United States. The program emphasizes accessible, quality healthcare for those who serve our nation.
Key trends and requirements shaping behavioral health contracting this year.
Major payers are expanding behavioral health networks, particularly for:
Increasing shift toward performance-based contracts:
Average timeframes for facility contracting:
Common facility credentialing requirements:
Our team specializes in helping behavioral health facilities navigate the complex insurance contracting landscape. We help you get credentialed with major payers and negotiate competitive reimbursement rates.
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