What is mental health credentialing?
Mental health credentialing is the process insurance companies use to verify a behavioral health provider's licenses, education, training, and work history before adding them to their network. Once you're credentialed and contracted with an insurer, you're "in-network": you can see that insurer's members and bill it directly at contracted rates.
Credentialing (verifying who you are and what you're qualified to do) and contracting (agreeing on terms and rates) usually happen together, and the whole process is often called provider enrollment or payer enrollment.
Who needs to be credentialed
Every licensed provider who wants to bill an insurance company in-network needs to be credentialed individually with that company. In behavioral health, that includes:
- Psychiatrists (MD/DO)
- Psychiatric Mental Health Nurse Practitioners (PMHNPs), and NPs and PAs working in behavioral health
- Psychologists
- Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), and other licensed therapists and counselors
Group practices also need the organization itself set up with each insurer, and each new clinician added as they join. See credentialing by provider type.
What you need before you apply
Insurance companies won't process an application until these are in place. Getting them ready first is the best way to avoid delays.
- CAQH ProView profile. Most commercial insurers pull your information from CAQH. Your profile must be complete, include current documents, and be attested. CAQH asks providers to re-attest regularly (currently every 120 days), and an expired attestation can stall an application.
- NPI Type 1 (individual). A unique 10-digit identifier from CMS. Make sure your taxonomy code matches your specialty.
- NPI Type 2 (organization), if you bill under a group practice with its own tax ID.
- Professional license(s) in every state where you see patients.
- DEA registration (optional). Only needed if you prescribe controlled substances.
- Malpractice insurance certificate showing current coverage.
- Education, training, and board certification details.
- Work history, typically covering the last five years, with any gaps explained.
- Practice details: service locations, tax ID, and W-9.
Choosing insurance networks
Which commercial insurance companies matter most depends on where your patients are. Blue Cross Blue Shield plans, Aetna, Cigna, UnitedHealthcare, and regional plans all have different market share state by state, and some behavioral health benefits are managed by separate behavioral health organizations rather than the medical plan itself.
Consider which plans your target patients have, each network's reimbursement, and whether it's accepting new providers of your type in your area. Some networks are "closed" to new providers in certain regions, and knowing that up front saves months.
The credentialing process, step by step
- Intake and payer selection. Confirm your documents, CAQH profile, and NPI are ready, and decide which insurance companies to apply to.
- Applications. Obtain each insurer's current application (often online, sometimes paper) and complete it so it matches your CAQH profile exactly. Mismatches are a common reason for requests for more information.
- Submission and verification. The insurer verifies your license, education, board certification, malpractice history, and sanctions with the original sources.
- Follow-up. Insurers rarely give updates on their own. Regular follow-up catches missing items and keeps the application from sitting in a queue.
- Contract and approval. Review and sign the contract, then receive your approval and provider ID.
- Effective date. Confirm the date your participation starts. You can bill in-network for services from that date forward.
Telehealth and multi-state credentialing
For telehealth, what matters is where the patient is located at the time of the visit. You need a license in that state, and you need to be credentialed with insurance companies that cover patients there. A provider licensed in three states may need separate applications, or at least separate plan enrollments, for each state.
Interstate licensure compacts can make getting multi-state licenses easier for some professions, but insurance credentialing is still handled with each insurer. Also check each insurer's telehealth policies, since some require your service address and telehealth setup to be listed a specific way.
Timelines and common delays
Timelines vary widely by insurance company and state. Many commercial payers take a few months from a complete application to approval, and some take longer. The most common causes of delay are:
- Incomplete applications or missing documents
- A CAQH profile that is incomplete, outdated, or not attested
- Information that doesn't match between the application, CAQH, and your license or NPI record
- Unexplained gaps in work history
- Slow responses from primary sources such as schools and licensing boards
- Closed networks in your area
Staying credentialed
Credentialing isn't one-and-done. Insurers require re-credentialing at least every three years, and some require it more often. In between, you need to keep your information current with every insurer: new locations, license renewals, malpractice renewals, and changes to your practice. Keeping your CAQH profile attested is part of this, too.
How Becker Credentialing can help
Becker Credentialing Services handles mental and behavioral health credentialing with commercial insurance companies, for providers in any state, including telehealth providers. We recommend payers, complete and submit your applications, follow up until you're approved, and confirm your effective dates. Then we handle re-credentialing and maintenance to keep you in-network. We also provide behavioral health billing.
What we don't do: Medicare or Medicaid enrollment, or setting up CAQH profiles and NPI numbers. Those stay with you, and we'll tell you exactly what's needed before we start.
See our credentialing services
FAQs
What is the difference between credentialing and contracting?
Credentialing is the insurer verifying your qualifications. Contracting is agreeing to the insurer's terms and rates. Both are needed before you're in-network, and they usually happen as part of the same enrollment process.
Do I need to be credentialed separately with each insurance company?
Yes. Each insurance company runs its own credentialing process, although most commercial insurers pull your core information from your CAQH profile.
Do telehealth providers need to be credentialed in each state?
You need a license in each state where your patients are located, and you need to be enrolled with insurance companies for patients in those states. Requirements vary by insurer.
How often do I need to re-attest my CAQH profile?
CAQH currently asks providers to re-attest every 120 days. If your attestation lapses, insurers may pause credentialing or re-credentialing until it's current.