How To Get On Insurance Panels As A Preferred Provider – Part 2

Oct
6
2011

This is the second of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. The series began here.How to Get on Insurance Panels - Part 2

Managed care companies receive hundreds of applications from licensed mental health professionals every year who are wanting to become preferred providers.  That’s why it’s important to make your application stand out in a positive way to the professionals in Provider Relations that will be evaluating your credentials and experience.  Here’s a few tips that I’ve learned over the years that may help you rise to the top of the pile.

Tip #1 – Focus on your own efficiency and your ability to save on costs. Managed care came into existence as a reaction to offset the rampant financial abuses in health care.  As such, the primary goal of these companies is to reduce costs of health care.  The care of clients comes second. Make sure that your application speaks to managed care’s concerns and not just your own.

Tip #2 – Location makes a difference. (And, not just for the reasons I stated here.) If you can provide services in an under-served area, you are more likely to be admitted to a preferred provider list.  If you currently provide services in a therapist-saturated market, you may want to consider adding a second site to your practice.  By indicating that you are available to provide services in an under-served area for just a few hours each week, you make yourself much more desirable to managed care companies.  (And, the good news is that once your are “in” on the panel, you can typically relocate your services without losing your place on the provider lists – even across state lines!)

Tip #3 – Highlight second languages that you are fluent in. Your unique expertise is what will get you on the list so don’t forget to highlight an ability to speak a foreign language every chance you get.

Tip #4 – Special hours can set your practice apart. Most therapists work 8 a.m. – 5 p.m.  If you can offer late or early hours or are willing to work on weekends, mention them on your application. Those “special” hours can be a way to expedite your entrance into the world of preferred providers.

Tip #5 – Special populations require special knowledge. Don’t indicate that you “work with everybody.”  That’s not what managed care is looking for.  Instead, if you have advanced training and experience working with a specific population or two, emphasize this. Populations such as geriatrics, children, GLBT, deaf clients, etc. can open doors for you with managed care.

Tip #6 – Advanced training and credentials count. Although experience definitely counts, proof of skills via advanced training and credentialing make you much less of a risk to insurance companies and much more desirable to them, too.  Track your professional development and flaunt it in your application.

Do you have other tips that can help other licensed mental health professionals get on insurance panels?  If so, I hope you will leave them below.

And, on Monday, I’ll wrap up this series by sharing a couple of thoughts for those who have had their applications denied


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What They Don’t Tell Mental Health Professionals About Vetting Referrals In Graduate School

Jun
27
2011

Did you know that as a mental health professional, you are ethically required to vet the professionals that you refer your clients to?


I’ll bet they didn’t tell you that in graduate school - at least not directly.  That’s why I’m always amazed at my colleagues who are always posting things like “I’m looking for a licensed therapist in Florida who is on United Health Care’s panel to refer a 10 year old boy with Bipolar Disorder to.” What I’m really thinking is “ARE YOU KIDDING ME?!”Image of Caution!

That may fly for your managed care company. Remember?  Their code of ethics and priorities are not the same as yours. However, you should know that according to Barton Bernstien, JD, LMSW and other mental health attorneys that I have spoken to, there have been suits of malpractice won against mental health professionals for making referrals to poorly vetted professionals.

What’s an ethical psychotherapist to do?  Here’s what I recommend:

  • Keeping your client’s clinical needs in mind, always recommend to the best professionals that you can.  After all, isn’t that what you would want as a consumer?
  • Know who you are referring to.
  • Give your client all the information that you can to help him make an informed choice.
  • Don’t blindly choose from a list or a “directory” of providers.
  • Verify the credentials of the professional that you are referring to.
  • Only refer to professionals that you know to be ethical and competent.
  • And, most importantly, don’t refer to someone if you are not willing to bet your license on the professional that you are referring to!

Here’s the deal . . . . Our clients trust us.  They believe that we have their best interest at heart.  To throw a dart into the online directory and then refer to that professional with no additional knowledge is like throwing your client to the wolves.  Think about it!  How many therapists do you know who exaggerate their skills, are clueless about their limitations, or make blatantly false claims about their results?

Perhaps you noticed . . . this is just one more reason that networking both online and face to face is part of any responsible mental health professional’s job.  It’s how we meet, learn about, and responsibly expand our resources for our clients.

That’s how I go about vetting a potential referral. Do you have additional steps to take when vetting your referrals?

[A special "thank you" to the Private Practice Network of Denver's rich online discussion on this topic earlier this month.  It was the inspiration for this post.]
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How To Register With CAQH

Oct
14
2010

Emily Miranda, MSW is a Licensed Clinical Social Worker in Utah who was kind enough to pass on the following information about registering with the Council for Affordable Quality Healthcare (CAQH).

The CAQH website states this is aImage of CAQH

free serice to physicians and other healthcare providers that simplifies and improves the data collection process” for those professionals who choose to file insurance for their clients or choose to become preferred providers for managed care.”

Miranda says,

It is an online service that collects provider credentialing data so that you can more easily provide it to other insurance companies.  Just being registered with CAQH does not mean you are participating with all of the organizations they have contracts with.  However, it does allow you to release your information to participating organizations.

  • To get a CAQH provider number, you must start credentialing with a particular healthcare organization; that organization will request your participation in the CAQH Universal Provider DataSource. [Miranda started with Aetna.]
  • A list of participating organizations can be found at CAQH’s website.
  • After you start the credentialing process with a particular organization, you will receive a letter in the mail with your CAQH provider ID numberDo not lose this number. You will need it to log on and submit your credentialing information on the CAQH website.
  • When you receive your provider number, you will then be able to log on and register.
  • Click here to log in for the first time
  • Follow the instructions and complete all the information.  You do not have to do it all in one sitting, but to save the information you’ve completed and come back to finish later, you must hit the button at the bottom of the page that says “next”.  That will save the information you entered on that particular page, and all the pages prior to it.
  • After you enter all the information, you need to run an “audit” on your file to make sure that all the information is complete and correct.  The website instructs you to do this.
  • After that you “attest” all your information (you will also be instructed to do this by the website).  It will give you a message that your file is complete.  You are finished!

Be sure to save your username and password somewhere safe; you will need it to log on to the site in the future and update your information.

Emily Miranda, MSW, LCSW, thanks so much for sharing this with us!

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Do You Know Which Credentials Mean Something?

Aug
31
2009

Within just a few years of obtaining my license as a Licensed Professional Counselor, I began receiving invitations to grandfather in  to organizations (that I had not even heard of) to receive additional credentials.  I (wrongly) thought that since I was licensed, no other certifications would be of merit so I opted to let those opportunities (with the National Association for Alcoholism and Drug Abuse Counselors and the National Board for Certified Counselors) slip away.  Soon after the grandfathering periods expired, those two organizations mushroomed in influence and credibility and I regretted my decisions.

Since then, I’ve also received invitations to join national boards, accrue additional “degrees” and “licenses,” be included in national directories of “prominent therapists.” and receive additional certifications from other organizations.  It’s all very flattering at first glimpse. It’s also easy to see how new therapists can be particularly susceptible to the ploys of these vanity boards and diploma mills.

The truth is anyone including you can set up a board or “school,” provide training in EMDR, hypnosis or any other body of knowledge, and then provide a “certification.”  The training may have surpassed the standards in your profession

(Fake) Certificates by Rosered

"(Fake) Certificates" by Rosered

or it may not.  My point is that if you are new to this body of work, you won’t necessarily know enough to know about the quality of the training.  And, in either case, the certification that you receive may mean nothing.

After contacting the American Counseling Association, mentors and professors across the United States, here is what I know for sure:

  • Reputable certifying boards are familiar with the National Commission for Certifying Agencies and have membership in the National Organization for Competency AssuranceCheck this out first.
  • The certifying board should include prominent individuals in your field and you should be able to research them.
  • Reputable boards function to actually meet the needs of the members that they certify. You want more than just a certificate for your wall or directory listing for your money.
  • Reputable boards function independently.  Certification is NOT contingent upon joining a particular organization; however, they are closely affiliated with professional associations that you belong to. If your professional association does not refer to a certifying board as a resource, you should question why.
  • They are typically not-for-profit.  Ask and verify.
  • Reputable certifying agencies are transparent.  They are easy to research including their policies and procedures, established complaint and grievance processes, and codes of ethics / conduct.  If you can’t research on line or get a phone call returned in a timely manner, you should be questioning the veracity of this  organization.
  • Fees for certification should be comparable to those charged by similar certifying bodies.
  • Legitimate certifying bodies typically require you to provide proof of attaining certain levels of education and experience.  They don’t just take your word for it!
  • They often require an exam or submission of a sample of your work to verify that you possess the requisite body of knowledge.

You should question the credibility and motivation of any organization that claims to provide certifications or similar statements of worth but fail to adhere to the above standards.  Such organizations are often shams — more interested in your credit card than your profession and they are known as vanity boards or diploma mills.

Whether you stumble into them unknowingly or choose to use them to pad your vita and boost your ego, the end result is the same.  The general public is misled and you are at risk of tripping on your professional code of ethics . As a professional in the field of mental health, you are required to display only credentials that mean something.  As such, you need to do your research before thoughtlessly passing along your credit card for another certificate to post on your “Look At Me” wall.

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