Medicare Credentialing for Mental Health Providers

Medicare is a federal program covering adults 65 and older and certain individuals with disabilities. For mental health providers, Medicare credentialing involves enrollment through the PECOS system and a process that differs meaningfully from commercial payer credentialing. TheraProfessional manages the full Medicare enrollment process for individual providers and group practices.

What Medicare Credentialing Involves

Medicare credentialing for mental health providers is completed through PECOS, the Provider Enrollment, Chain, and Ownership System. Unlike commercial payers, Medicare does not use CAQH as the basis for enrollment. The process involves several steps that must be completed in the correct sequence to avoid delays.

Who We Work With

•        LCSWs credentialing with Medicare as a covered behavioral health provider type

•        Psychologists enrolling in Medicare for the first time or in a new state

•        PMHNPs enrolling in Medicare for psychiatric services

•        Group practices completing Medicare enrollment and reassignment for new providers

•        Providers who have moved and need to update their Medicare enrollment for a new practice location

•        Providers reactivating lapsed Medicare enrollment

What We Handle

•        PECOS account setup and individual provider enrollment

•        Medicare enrollment application completion and submission

•        Supporting document preparation and upload

•        Group NPI enrollment and provider reassignment for group practice clients

•        Follow-up with Medicare Administrative Contractor during review

•        Enrollment confirmation and billing number verification

Frequently Asked Questions

How long does Medicare credentialing take?

Medicare enrollment through PECOS typically takes 60 to 90 days for individual providers. Group enrollment and reassignment steps add time and should be initiated simultaneously where possible.

Which mental health provider types can bill Medicare?

LCSWs, psychologists, and PMHNPs are covered provider types under Medicare Part B. LMFTs, LPCs, and LMHCs were added as covered provider types under recent legislation and are now eligible to enroll.

What is Medicare reassignment and do I need it?

Reassignment is the process by which an individual provider assigns their Medicare billing rights to a group practice entity. If you are billing under a group NPI, reassignment must be completed before the group can bill Medicare for your services.

What does Medicare credentialing cost?

Our standard rate is $300 per payer or $275 per payer when credentialing with four or more payers at once. We provide an exact quote after a free consultation.