Close this search box.

Navigating the Nuances of Credentialing for Behavioral Health Services

Without a doubt, the COVID-19 pandemic has brought major changes to the healthcare market. From staffing issues to the decline of in-office visits, the normal day-to-day routines of practices were suddenly uprooted.

Since the beginning of COVID-19, a spotlight has been placed on one area that may have been overshadowed in the past—mental health. During the pandemic, about 4 in 10 adults in the U.S. reported symptoms of anxiety or depression. According to a survey conducted by the Larry A. Green Center, more than half of clinicians reported declining health among patients. Even more striking, over 85 percent reported a decline in patient mental health with 31 percent seeing a rise in addiction. The cause of this can be attributed to many pandemic-related factors, such as woes and limitations placed on social interactions.

Thankfully, the meteoric rise of telemedicine became a new way of providing care and allowed patients, many quarantined at home, to seek care virtually. While it may seem like a common aspect of healthcare at this point, telemedicine is not going away. If anything, it’s increasing. As the pandemic endures, the need for mental health specialists continues to grow. This newfound virtual way of providing care, and the overall need that exists, has caused more providers to take on behavioral health services.

New practices are opening up and providers are expanding their services. But, of course, in order to legally offer (and be reimbursed for) behavioral health services, a provider must be properly credentialed. Having to navigate credentialing for these services, including telemedicine, is not as easy as it seems.  Complying with the Council for Affordable Quality Healthcare’s (CAQH) credentialing requirements can be a challenge for even the most seasoned behavioral health professional. On average, the time required by behavioral health professionals for credentialing is up to five times greater than for traditional professionals because of nuances specific to the industry.

It is also said that ninety percent of network applications for therapists and counselors are denied. That’s a striking statistic. What explains the reason behind this issue? Well, some payers are simply not as familiar with behavioral health as traditional medicine. Even though physicians specializing in these services are in high demand, unnecessary roadblocks often arise. One issue that may pop up involves a network reaching capacity. Perhaps a network is not allowing new specialists that focus on one behavioral health-related area, like autism, for example. In addition, some payers place limits on applicants lacking advanced degrees. Unexpected issues like these lead to credentialing complexities that many providers are simply not equipped to handle.

While the extreme need for behavioral health services over the last 18 months has no doubt resulted in new provider enrollment applications, the truth of the matter is that improper credentials can lead to high denial rates for behavioral health claims. So how can mental health providers easily gain and maintain their credentials as the first step in managing their practice efficiently? The key is to stay ahead of enrollments to avoid credentialing-related denials.

TriZetto Provider Solutions’ (TPS) credentialing experts understand the complex landscape and have direct relationships with all major payers. Our knowledge helps ensure continuous payer follow up and insight into enrollment status. TPS allows you to do what you do best – manage patient care – by alleviating the burden of credentialing and making sure you never miss quarterly re-attestation deadlines.

If you need assistance navigating the nuances associated with behavioral health credentialing, let us be your trusted partner. Learn how a complete end-to-end credentialing service and other solutions from TPS can help your practice simplify credentialing and more.

– TriZetto Provider Solutions Editorial Team

At TriZetto Provider Solutions, we aim to simplify the business of healthcare. By combining intuitive software and customer-focused services with in-depth industry knowledge, we provide complete revenue cycle solutions and credentialing management services that empower our clients to succeed and maximize reimbursement. Fueled by Cognizant, our collective expertise and global reach allows you to keep a pulse on your provider enrollments and financial health so you can focus on the health of your patients.

Leave a Comment