How to Get Credentialed With Insurance as a Therapist

Getting credentialed with insurance is one of the most important and most misunderstood parts of building a private practice. Providers are often told it takes forever, that it is too complicated to do without a platform, or that they should just sign up for Headway or Alma and let someone else handle it. None of that is accurate.

Credentialing is a process. It takes time and attention, but it is entirely manageable with the right support, and the long-term financial difference between platform credentialing and independent credentialing is significant.

What Credentialing Means

Credentialing is the process by which an insurance payer verifies your qualifications, licensure, training, and practice information, and then issues you a contract to participate in their network as an in-network provider. Once you are credentialed and contracted with a payer, you can bill them for sessions with clients who have coverage through that plan.

Until you are credentialed, any client with that payer who wants to use their insurance benefits for your services would have to pay out of pocket or seek care with a different provider.

What You Need Before You Can Start

You must have an active, unrestricted license to practice in the state where you intend to see clients. Credentialing cannot begin before licensure is granted.

You need a Type 1 National Provider Identifier, or individual NPI. This is a free 10-digit number you obtain through the NPPES registry at nppes.cms.hhs.gov.

You need malpractice insurance. Most payers require a minimum of $1 million per occurrence and $3 million aggregate.

If you are operating as an LLC or other legal structure, you should also obtain a Type 2 NPI for your business entity, though this is not required for sole proprietors in every state.

Step 1: Set Up Your CAQH Profile

CAQH ProView is a centralized database where you enter your credentialing information once and share it with multiple payers. Most major commercial payers pull directly from CAQH when processing your application.

Setting up CAQH involves entering your personal and professional information, uploading your license, malpractice certificate, and other documents, authorizing payers to access your profile, and attesting that the information is complete and accurate.

Attestation must be current. If your attestation expires during the credentialing process, some payers will pause your application until you re-attest. We monitor this for all of our active clients.

Step 2: Identify Which Payers to Apply To

The payers worth credentialing with depend on your location, your license type, your target client population, and which plans are commonly carried by people in your area.

For most therapists in most markets, the highest-priority payers are some combination of Aetna, Cigna, UnitedHealthcare, and the dominant regional Blue Cross Blue Shield plan. Medicare may be a priority depending on your client population. We advise every client on which payers to prioritize before any applications are submitted.

Step 3: Submit Applications to Each Payer

Each payer has its own application process. Some use their own provider portals. Some use third-party systems. Some still require paper applications or faxed submissions in certain situations.

The information needs to be consistent across every application and consistent with what is in your CAQH profile. Discrepancies between your CAQH profile and your payer application are a common cause of delays.

Step 4: Follow Up Throughout the Review Process

This is the step that most providers underestimate. Credentialing departments at major payers are processing a high volume of applications. Applications that are not actively followed up on sit in queues longer than they should.

Effective follow-up involves checking the status of your application regularly, responding promptly to any requests for additional information, and escalating when an application has been pending longer than the payer's stated processing window. We handle all of this follow-up for every application we manage.

Step 5: Confirm Your Contract and Effective Date

Once your application is approved, the payer will issue a contract. Review it carefully, particularly the fee schedule. Once you sign, your effective date is established and you can begin billing for clients covered under that plan. Save a copy of every contract you sign.

Should You Credential Independently or Use a Platform

Independent credentialing costs more upfront and less in the long run. Platform credentialing costs nothing upfront and a great deal in the long run.

With independent credentialing, your contracts are between you and the payer. You own your panel memberships. If anything changes in your practice, your credentialing goes with you.

How TheraProfessional Can Help

We manage the entire credentialing process for therapists, psychologists, LMFTs, LPCs, and PMHNPs. We set up your CAQH profile, identify the right payers for your practice, submit applications, follow up throughout the review process, and confirm your contracts.

Our clients focus on building their practices. We handle the credentialing.

"Learn more about CAQH and how to set up your profile correctly." →

"See a realistic breakdown of credentialing timelines by payer." →