Mental Health Credentialing Services

Why credentialing is a revenue problem

Credentialing for mental health providers is the step that decides whether a claim can be paid at all. A clinician who is not enrolled with a payer, or whose enrollment lapsed, produces denials on every session with that payer’s clients. The denials say the provider is not eligible, and no corrected claim fixes them. The only fix is credentialing, and by then the timely filing clock has been running.

Resilience Billing is a mental health billing company, and credentialing review is the first thing we do for every new client. If a panel is about to lapse, we tell you before the first claim goes out. Updates and new applications are then processed under our credentialing fee structure, which is separate from the billing fee. See denial management for how credentialing errors show up in the aging report.

CAQH setup and attestation

Most commercial payers pull a provider’s information from CAQH ProView. An incomplete or unattested profile stalls every application that depends on it. We build the profile completely, upload every document, authorize each payer to access it, and re-attest on the payer’s schedule so the profile never goes stale.

Payer panel applications and timelines

We apply to the commercial payers and behavioral health carve-outs that matter for your area and your clients, and we follow up on a schedule until each one is approved. Timelines vary by payer, from weeks to months, and the difference is usually a complete application and prompt answers to payer requests. We record contract effective dates and fee schedules in your EHR so payment posting can catch underpayments later.

Group versus individual: Type 1 and Type 2 NPI

Every clinician has an individual Type 1 NPI and is credentialed as an individual. A group practice also enrolls under a Type 2 NPI, and each clinician is linked to the group with each payer so the group bills and receives payment. When a group hires, the new clinician needs both the individual credentialing and the group link before insured clients can be scheduled. We handle both and track the effective dates so early sessions are billable.

Medicare enrollment for LPCs and LMFTs

Medicare now enrolls licensed professional counselors (LCPC, LPC, LMHC) and licensed marriage and family therapists (LMFT), alongside psychologists, clinical social workers (LCSW), psychiatrists, and Nurse Practitioners. For counselors and marriage and family therapists who have never billed Medicare, that means PECOS enrollment, a decision about participation status, and an understanding of Medicare’s documentation and telehealth rules. Our guide on whether LPCs, LCPCs and LMFTs can bill Medicare covers the details.

Re-credentialing

Payers re-credential on a cycle, and CAQH asks for attestation regularly. Miss either and the panel lapses quietly. We track every expiration and renewal date, respond to payer re-credentialing requests, and keep the licenses and malpractice documents on file current. Re-credentialing, like all of our credentialing work, is offered to our revenue cycle management clients under a separate credentialing fee structure.

Who does the work, and where

Credentialing is done by our own staff in Woodstock, Illinois, people who have run credentialing for a private practice and know which payer requests can be ignored and which cannot. We serve practices nationwide, with the exception of New York and New Jersey. Request a consultation to review your panels.