How To Get On Insurance Panels As A Preferred Provider – Part 1

Oct
3
2011

This is the first of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. How to Get on Insurance Panels - Part 1

I was scanning emails on one of my favorite online discussion lists, the Denver Private Practice Network, [as of 11-04-2011 known as the Denver Therapists' Network] when I ran across an inquiry from Licensed Professional Counselor, Becky Bringewatt of Mantis Counseling and Coaching Services of Denver, Colorado.

I am applying to [insurance] panels and have not been able to get on because they are full or full for my therapies at this time. I would appreciate any help with this, too.”

I suspect that many of you are struggling to get on insurance panels as a preferred provider.  Although I no longer choose to work directly with insurance companies [You can see why here], I know that many of you still choose to do so.  In this post, I’m providing the steps you need to go through to apply to become a preferred provider with an insurance company.

Step 1 – Get organized. I can’t stress this enough.  Insurance companies are going to want lots of information including              .  Get organized.  If you are going to apply to be on lots of insurance companies, you might as well make lots of copies of your licenses, proof of malpractice insurance, resumes, and other supporting documentation.  Just do it now to streamline your process.

Step 2 – Make a list. Insurance companies vary considerably in the amounts they will pay providers.  They also vary in how quickly they will reimburse you, how “provider-friendly” they are, and how many hoops you will be required to jump through to obtain reimbursement.   That means that it makes sense to be strategic about which insurance companies you choose to be a provider for as well as the order in which you apply. Ask your colleagues who are already preferred providers  what their experiences have been with any given company before making that list.

Step 3 – Contact Provider Relations. Call each insurance company that you want to work with and ask to speak with Provider Relations.  Every company has someone in this position that can speak frankly with you about their application process.  Request an application.  They will most likely re-direct you online but this is a good opportunity to start building a human connection.  And, while you are at it, ask them what their unique clinical needs are.  Every company’s needs are different.

Step 4 – Use your personal contacts. If you’ve already been networking in the field, it’s likely that you have already run across individuals who work in managed care or indirectly with managed care.  If you haven’t met those individuals already, now is the time to put that on your networking to-meet list.  Employee assistance programs (EAPs) and those employed in provider relations can provide you with shortcuts (like what the needs of that particular company are) and tips (like what most therapists forget to include in the process) for getting your application accepted.  Pick their br

ains!

Step 5 – Complete the CAQH. The application process can be lengthy and arduous. Plan on 20-30 page applications for most insurance companies and plan on about 50 pages for Medicare applications. The Council for Affordable Quality Health is an online service that allows you to complete one application that over 100 managed care companies use.  That can save you a lot of time so consider complete the CAQH to cut down the amount of paper work (potentially 2000+ pages) in the process.  (Check out this guest post on how to register with CAQH.)

Step 6 – Copy everything you include in your application. It is not unheard of for applications and supporting documentation to be lost, misplaced, or actually shredded after it leaves your hands and long before the application process is completed.  Make sure you copy everything and keep detailed notes about when, how, and who you talk to in Provider Relations and who said what.  It is likely that you will need these notes later on so that you sound competent, clear-headed, and informed.

Step 7 – Create and keep paper trails. I’m all about saving trees and minimizing the clutter that can come with paper.  However, communicating in writing with managed care can be your saving grace down the road.  I recommend that you communicate by phone or face to face to nurture the relationships that you are developing with managed care.  However, always follow up important conversations via email so that you will have a paper trail to confirm your understanding of contractual details and expectations.  Honor and the spoken word is not enough.

Step 8 – Submit your application and supporting documentation in a timely manner. You will likely be rejected as a provider if you fail to submit a complete application and respond to any additional requests in a timely manner.  Those employed in Provider Relations refer to failures of this nature as “timing out.”  In order to avoid having your application rejected solely because it has timed out, you will need to stay organized and efficient and respond to their requests for additional information quickly.

Step 9 – Follow up. Once your application and supporting documentation has been submitted, your job is not done.  You should again contact Provider Relations and ask them about the timetable for processing your application.  I recommend that you contact Provider Relations at least monthly until you have a final disposition of your application.

On Thursday, I will share with you some of the ways to make yourself more desirable to insurance companies in Part 2 of this series, How to Get On Insurance Panels as a Preferred Provider.

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Comments

  1. Perfect timing, Tamara! This is exactly what I am working on this week. My practice specialty is working with people living with cancer, chronic and serious illness. Seems most referral sources want to know what panels I am on. Right now, and at this time I am on no panels. Hoping to change that soon! Thanks again!

    Best,
    Bethany

    • Hi, Bethany! Thanks so much for dropping in this evening to chat! I love that you know what your niche is – and a fabulous one, at that! And, I just checked out your website and love the image you have of “This is what healing looks like.” Beautiful!

      You have no need to worry about not yet being on any panels. That will not count against you at all when applying to be on insurance panels. Good luck with the process! Let me know if I can help in any way!

  2. perfectly timely

    • Hi, Meira! Welcome to Private Practice from the Inside Out! Thanks for dropping in to chat. I’m glad you found the post useful and hope you’ll be back to add your thoughts to the conversation in the near future.

  3. Another great article! I have a question alongside that: I have applied to multiple insurance panels with a decent mix of acceptances and “we’re not accepting new providers right now”. But there’s one I haven’t heard back from and I cannot seem to get through their automated system or find an email address to ask if I’ve been accepted or rejected! Any tips for getting through to an actual person?
    Also, I’ve been accepted as a non-network provider for another company, but same issue: no one has told me what that means, what plans I can accept, or how to file! Help please!! I need advice.

    • Good morning, Stephanie! Thanks for the RTs this morning and dropping in here to chat.

      Hopefully, some of our readers here will have some suggestions for you because I’m just problem solving on the fly this morning. Here’s a few things to try . . . .

      1. Leave the names of the companies here. They may be reading, too, or some of our readers may have human contacts that they can share with you to help you get inside the companies.

      2. Have you tried just googling the name of the company along with “provider relations”?

      3. I know this sounds obvious but . . . you may want to write a good old fashioned letter of inquiry and send it via snail mail. Or, if you have tried that already, send another copy of it by Certified Mail.

      4. Contact other professionals who are already working within this system as preferred providers. Ask them how they typically get their own questions answered.

      5. And, if you cannot get the company to return your phone calls or respond to your inquiries, as a last resort, you may want to consider filing a complaint – with a parent company, the Better Business Bureau, the National Association of Insurance Commissioners, or the Attorney General in your state.

      Stephanie, if you try any of these and have any success, I hope you’ll drop back in here to let us all know and learn from you!

  4. That is a good idea! I didn’t think about Googling Provider Relations, I will try that. The one I can’t find out if I’m accepted into is United Behavioral Health, and I have been accepted as a authorized provider by TRICARE and can file claims but I am not a contracted provider at this time. Not sure what that means or if I would want to become a contracted provider….Yipes!

    • OK, gang! Can you help Stephanie out? I know there are some stellar networkers on this this list so can you introduce Stephanie to a UBH professional or two? Know the ins and outs of TRICARE? Share the info right here and we’ll all learn from YOU!

  5. Tamara, I can’t believe you are posting this now. All I’ve been doing all week is sending in credentialling paperwork, hehe. If anyone knows how I could get a human response from anyone at the medicaid office in Georiga, that would be a great help.

    • Hi, Jill! It’s good to have you back here!

      OK, gang, can you help Jill out? She’s needing a human contact at the Medicaid office in Georgia!

      (And, Jill, I hope you’ll drop back in with the name and contact info for that person when you get it.)

  6. I am also interested in knowing about any insurance companies that you just love to work with, good provider relations, pay in a timely manner, etcc. and who takes people with less than two years licensed.

  7. Hi Tamara: Very good list for folks attempting insurance panels. I would add one thing and that’s to make sure the panels know of any specialties you might have and make sure to include that in your applications. Also, don’t rule out EAP panels. While some of them don’t pay as well as the heavy hitters, it’s a great way to build up client base, many of whom will choose to stay with a therapist once they start seeing someone under their EAP benefit. And the other suggestion is to be persistent. It took me nine months and several phone calls and emails to finally get approved.

    • Thanks, Valerie, for dropping in here. I had mentioned to readers that I was hoping you would be able to drop in to share your own ideas about this topic. Thank you thank you!

      I’ve addressed specialties in the next post and referenced EAPA in the final post in this series. However, I appreciate you stressing that EAP panels and the possibility of clients choosing to remain with a therapist (after their EAP benefits run out).

      And, I want to underscore that you . . . the ex-managed care insider:) . . . has indicated that therapists interested in contracting with managed care companies must follow up. Persistence matters!

    • How do I join the EAP panels, please:)

      • Contact the EAPs that you are interested in working with. Ask for Provider Relations. Tell them that you want to become a provider and ask them how to do that. They will typically direct you to a website where you can fill out an application. The guidelines here for getting on insurance panels generally applies to Employee Assistance Programs, too.

  8. I was just wondering the best way to make sure you note your specialty on your applications, some applications seem so general and also sometimes you just have a pre-application. Also if you can advise on how to get around the “you have to be licensed 2 years” line.

    • Sure, Jill! Applications may seem to be asking for general information but any time you have the ability to answer an open-ended question, you have the opportunity to emphasize a niche – and, the more specific, the better! Don’t give in to fears and “not-enough” thinking. An emphasis on being a generalist will only make your forgettable.

      The requirement that you be licensed for X amount of years, is actually much more difficult to address if you don’t already meet this requirement. I have no idea if managed care companies even consider waiving this one but if they do, here are some of the things that might make them take a second look at you . . . .

      If you are relocating from another state in which you had licensure OR if you are currently under clinical supervision and also engaged in consultation . . . . Those things might increase the likelihood. But, a smarter way to make early inroads into managed care would be good old-fashioned, off-line, face-to-face networking with managed-care insiders who are already working with the company that you want to work with. They could tell you if and under what circumstances expceptions are made.

      Thanks, Jill, for extending this conversation with your probing questions . . . . It is information that a lot of our community is in need of!

      • Thanks Tamara. Those are very good pointers, I have just been working on a lot of these applications, and some of them I have already sent in, but I am glad to read these posts. I am glad to hear you say to show a niche, so many want to be generalists, but I think that if you do that you are missing out on finding work that you love and seeing the clients you enjoy working with. Even if it takes more time to build a practice it may be worth it. I am writing this as I am tempted to take anything that walks in the door that will pay my fee right now because there’s those burning bills to pay in the back of my head.

        • Jill, I see that you and Tanya both are chomping at the bit to get those clients in the door. In my experience, the tighter that niche, the faster the right clients will find you. I know it sounds . . . feels counter-intuitive but it works.

  9. Having a niche is my biggest selling point. I only work with children ages 3-12. When parents or caregivers initially contact me it’s because they want someone who is specialized. That means they have confidence in me from the start.

  10. Dear Tamara:

    I was reading your article which I thanked you so much for as I am a lose child in the private practice world. I was wondering if number 5 applies to me. I am in California. I just quit my job because there is no quality of care when you work with agencies that are contracted with the Department of Mental Health here in California (in other words Medi-Cal). I am tired of the paper work that never ends and you end up earing less than a $1.00 per hour. Anything you can tell me, will be very much appreciated. I really, really want to start my private practice and what better time than now.

    With lots of gratitude towards you for posting these wonderful articles. I am honor to have come across them.

    • Hi, Karla! Welcome to Private Practice from the Inside Out!

      I started out working in agencies and psych hospitals so I certainly understand the fatigue and disillusionment that can set in from working with the neediest in our community agencies. When my own frustration and burnout reached a tipping point, I headed into private practice. I always knew that that is where I would end up . . . I just never realized how difficult it would become to work in community agencies.

      There are many reasons new therapists should start their careers in the employment of non-profit agencies, organizations, and institutions. A stint in those settings can teach you more in one year than you can possibly learn in graduate school. Still . . . when it’s time to go . . . it’s time to go.

      I’m excited for you as you begin to consider making the move into private practice! And, if you know that you want to apply to get on preferred provider panels with managed care, then yes, you can definitely use CAQH to shortcut that process.

      I’m excited for you, Karla, as you are thinking about starting your private practice! I hope you will drop in often to find the information and resources you need and chat, too! Tell your colleagues about PPIO and invite them to share their experiences here, too! It’s how we keep this online community rich with resources, support, and inspiration.

      Blessings to you on your journey!

      • Dear Tamara:

        I was just at the CAQH site and I must say I was intimidated by it as it asks for personal information. I want to start my private practice but I am lost. I did not know if I should sign up with CAQH since I don’t have any clients. Please help.

        Also, where should I start regarding clients.

        Thanks so much.

        • Karla, CAQH sill be asking you for the same type of information that managed care companies will be asking you for. If you want to work directly with managed care and file claims on behalf of your work with your clients, you will have to give up some privacy – and that of your clients, too. It’s one of the reasons that I don’t work directly with managed care. (Here’s more reasons my practice is managed-care free.)

          As for where you should start, the short answer is . . . it depends. (I’m sorry! I know that’s not what you want to hear . . . but it’s true!) Here’s what I mean . . . . If you are getting clients to book appointments but they aren’t returning, that’s one issue. But . . . if they are calling but aren’t even booking an initial appointment, that a different problem. Or, if they know you exist but the phone isn’t even ringing, that’s yet a different problem. And, if they don’t even know you and your practice exist that’s an even different problem. So, the first place to start is to identify where your clients are in the pipeline and fix the leak.

          Does that make sense, Karla? I’ll be blogging about these different “Leaks” in the next few months to help you get up to speed. (And, of course, if you are in a bigger hurry than that, feel free to shoot me an email about hiring me to coach / consult with you 1:1.) Either way, I’m looking forward to supporting you in building your ideal practice!

  11. Christine nunez says:

    How can I be a provider for insurance companies just starting therapy business

  12. Hi Tamara;
    First I want to thank you for your sharing your knowledge in this field. I am currently accepting only Medical Insurance in my private practice in an underserved area in East Bay California and interested in joining the panel. However, I am quite new and lost as to whether the panel is an entity that includes all insurances or each insurance company has its own panel. In case I need to apply for each insurance separately what is the list of insurances in my area covering for psychotherapy services?

    Thanks
    Soheila

    • Soheila, every managed care company has their own panel of providers and each company may or may not choose to allow you on to that list.You will need to apply to each company individually. However, if you first complete the CAQH application, it can shorten your efforts by using that one application form each time you pursue getting on another panel. Best wishes on your journey!

  13. Hi Tamara.

    If I am in a group practice can I also have my private practice in another office? This would imply that some bills for services will be sent from the group practice and others will be just submitted by me for those clients that I see in my private practice. It that possible?
    Thank you for this website!

  14. Hi Tamara,

    I am interested in joining a network to provide counseling via internet or video. Do you know any companies that recruit licensed professional counselors in this area?

    • Psychesync, welcome to Private Practice from the Inside Out! Are you asking about companies who hire professional counselors specifically for distance counseling? Or, are you talking about companies who simply list professional counselors for distance counseling?

      • I’m asking about companies who simply list professional counselors for distance counseling.

        • Psychesync, I apologize for the delay in getting back to you. Thanks for even asking this question. I hadn’t thought of it or recognized the need until now. I needed to do a little research. I can see that I will need to do a blog post on this soon but here is one directory that I found – The American Distance Counseling Association . I hope others will join me in adding their organizations to this. I would like to create a blog post with a list of others.

          I hope this helps get you started!

  15. If I am considered 1099 contractor at a practice, should I be paneled individually or under the practice group? Also, should I be entitled to have a copy of the contract? Thanks for your help!

    • Depending on the individual insurance company’s policy, you might be able to be paneled either way; however, if you anticipate wanting to work as a solo practitioner down the road, I recommend that you go ahead and make the effort to get paneled individually. It’s the easiest way to make the transition into a solo practice later on. Also, you should note that if you plan to see clients outside of your group practice and want to be able for your clients to file on that insurance company, you will need to be individually paneled.

      And, either way, I would always ask for a copy of the contract for your own records; barring access to that contract, I would always keep a copy of your applications for paneling, too.

  16. I am so glad I found this site! Thank you for being here and providing some great information! I am working on starting my private practice and just imagine someone nodding quietly to all the frustrations re: credentialing!! What a daunting process! I keep a notebook with a page for each panel I’m trying to get on and keep detailed notes on the date and name of the person I’ve talked to. I definitely need to bump up my networking with all my counselor friends. Keep all the good stuff coming!

  17. Hi Tamara

    I heard that there is a method of applying to all insurances who have PPO plan through one system instead of sending application to each insurance company to be a provider . Do you have any Idea?

    Thanks

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