If you run a mental health center, addiction treatment center, or other healthcare company, one of the best ways to expand your client base and potential revenue stream is to become in-network with insurance agencies. Different insurance agencies can provide referrals and more structured pricing fees.
For many companies offering mental health services, it can be beneficial to become in network with multiple insurance agencies operating in the same area to widen their potential client base. However, the process can be complicated, very time-consuming, and different for each company.
How to Become In-Network with Insurance Companies
Steps for becoming in network with insurance agencies start with licensing, credentialing, and contract negotiations.
Licensing
One important step is to become a fully licensed practice or healthcare institution. If, for example, you are providing mental health or addiction treatment, and part of your services are done virtually, you will need to ensure that you have the proper licensing in each of the states where you want to operate.
Credentialing
Credentialing is an important part of your ability to become in-network with insurance agencies. Credentialing is where you establish your legitimacy as a healthcare provider or institution as well as your qualifications.
With proper licensing under your belt, you can move on to credentialing.
Note: You will likely have to undergo credentialing several times with each of the respective insurance companies or government insurance providers with whom you would like to become in-network.
Credentialing normally takes between three and six months, so it’s important that you begin the process early before you plan to operate in a specific region. This is a different process, application, and negotiation for each company. For example:
- Blue Cross Blue Shield requires that new healthcare businesses submit a Provider Enrollment request form, after which a Provider Relations representative reaches out with additional steps
- Cigna, by comparison, requires that you go through the credentialing process and then provide basic information through their website, like your licensing, board certification status, malpractice claims history, and more, after which the application will be reviewed in a matter of up to sixty days
The requirements will differ depending on the insurance agencies or government agencies with whom you want to work.
Note: There may be different steps in between credentialing and contract negotiations contingent upon the types of services you plan to offer. For example, behavioral specialists offering specific services for people with Autism or LGBTQ+ services, depending on the insurance agency, might need secondary credentialing or assessments before these services can be offered.
Contracts
Again, contingent upon the requirements from each insurance company once you go through your credentialing process, the next step to become in network with insurance agencies is to negotiate your contract. This includes negotiations over your fee schedule in particular, and how certain things are billed.
Your contract negotiations are also an important deciding factor for the timeline when you can begin billing clients in network and expanding the number of patients and the amount of revenue that you can generate.
As each of them have different applications, information requirements, and timelines, one of the ways that you can expedite this process and make it easier to become in network with insurance agencies in your area is to work with qualified consultants.
Becoming In-Network with Insurance Agencies Using C4 Consulting
With C4, we offer insurance credentialing consulting. Our specialists can help you prepare and submit any forms for the credentialing process to become in-network with insurance companies. We can also help you communicate back and forth with those companies to ensure that your application is processed properly and that your contract is negotiated.
We can work with you to ensure things like higher approval odds, a more favorable fee schedule, and even things like backdated contracts so that you can provide treatment much sooner. We bring a wide range of expertise to the table starting with insurance credentialing consulting and moving into things like startup planning, financial planning, and marketing.
Overall, becoming in network with insurance companies can be a lengthy process with licensing, credentialing applications, and contract negotiations. When you work with consulting companies, you can get help going back and forth with different insurance providers to make sure that your requirements are all respectively met and that you have an increased chance of a higher paying fee schedule once your contract is negotiated.
Contact C4 Consulting today to speak with our specialists about how to become in-network with insurance agencies in your area.
