The short answer: mental health credentialing is how insurance companies verify a provider before adding them to their network. Before you apply, you need an active license, an NPI number, malpractice coverage, and a complete, attested CAQH profile. Most commercial insurers then take a few months to approve an application, and complete applications with regular follow-up move fastest.
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. Profiles are managed at CAQH ProView.
- NPI Type 1 (individual). A unique 10-digit identifier from CMS. Make sure your taxonomy code matches your specialty. NPIs are issued through the CMS NPPES website.
- NPI Type 2 (organization), if you bill under a group practice with its own tax ID.
- An active professional license.
- 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.
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 work with you to choose the best insurance companies for your practice, 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.
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.
How long does mental health credentialing take?
It varies by insurance company, but many commercial insurers take a few months from a complete application to approval, and some take longer. Having your documents and CAQH profile ready before you apply, and following up regularly, are the best ways to avoid delays.
What's the difference between individual and group credentialing?
Individual credentialing verifies a single provider, using their license, Type 1 NPI, and CAQH profile. Group credentialing also sets up the practice itself with each insurer, using the group's Type 2 NPI and tax ID, and links each provider to the group's contract. A group practice needs both: the group set up once, and each clinician credentialed as they join.
How much does a credentialing service cost?
It depends on your practice. Becker Credentialing Services has different pricing for single providers, multi-provider practices, and groups. Contact us for a quote.
Does Becker Credentialing Services handle Medicare or Medicaid enrollment?
No. Becker Credentialing Services credentials with commercial insurance companies only. We don't handle Medicare or Medicaid enrollment, set up CAQH profiles, or apply for NPI numbers. Our billing services, however, do cover commercial, Medicare, and Medicaid claims.