Portland Therapy, Counseling, Coaching, Massage, Acupuncture, EFT

Private Practice 101

How to get on Insurance and EAP Provider Panels:
Demystifying the Process

 

Getting Started:  Start a list of companies you may apply to, (if you are going to do this, make a file for each company you are planning on applying to and keep all correspondence, notes and dates you make contact in order to stay organized).  Keep files of panels you are active on, panels you are in process of applying to, as well as ones you have not been accepted to, or have terminated your contract with.  Also start a file with copies your licenses, liability insurance face sheet, NPI number, and your vita to refer to for experience or references.  This will make your application process more efficient.
 
Questions to ask: 
Get to the Provider Relations department, by phone or email, ASK
 
*Is your company accepting new mental health providers in the Portland (your) area?
 
*Do you accept LPC’s, LMFT’s, LCSW’s etc (your licensure)?

*Do you have post licensure requirements? (some companies require that you have two to three years post licensure experience)?

*What are your reimbursement rates (also called allowable fees)?

*How would I submit an application to be an in network provider or panel member?
 
*Or What is your application process?
 
Application:  If they are accepting new providers, they may ask you a little about your specialties, and may offer to send you an application, fax it, or email it, or they may refer you to their website to begin the process of applying.  The application process entails filling out forms describing your credentials, experience, current practice, specialties, professional references, and providing proof of license, liability insurance (1 million/ occurrence, 3 million/ aggregate, minimum coverage), and possibly going through a credentialing service such as CAQH that many companies refer to rather then completing their own verification.  Applying should not cost you anything but time and energy for the most part, and is pretty self-explanatory.  I have only ran across a couple panels or credentialing services that required a one- time fee.  Once you fill out a couple of the applications it feels less overwhelming.
 
Waiting:  Submit your application, and mark in your file when you submitted it.  It may take 3-6 months for these companies to complete the process, so I like to check in after three months to ask about the status of my application if I have not heard anything.  Ultimately you should get a letter accepting you, (and an “executed contract” which you are to sign and return in order to activate your status), or an explanation why you are not being accepted at this time.  Reasons for this are usually that they have enough providers of a certain specialty in your region, or require more post licensure experience or do not accept your credentials.  In some cases it is worth filing this and reapplying in the future, unless of course you are so busy by then that you do not need more business!
 
It takes some patience but is well worth it to be getting a steady stream of calls from potential clients who you can say yes to!!!
 

____________________________________________________________

Rachel Starck is a Licensed Professional Counselor in private practice at The North Portland Growth Place.  For more about Rachel’s practice and part time office space, go to www.thegrowthplace.com