How to Get Credentialed with Insurance Companies as a Rehab Facility

A Guide to the Credentialing Process for Treatment Center Owners

As a rehab owner, you may already be familiar with the challenges of credentialing, as well as those involved with acquiring an in-network status.

Fortunately, our guide on how to get credentialed with insurance companies as a rehab owner is here to help smooth the process and give actionable strategies for success.

Again, as an owner or senior manager, you already know that owning an addiction treatment facility as a healthcare provider requires a close relationship with the insurance agencies that provide coverage to your clients. Even if your facility is considered one of the top-notch medical providers in your area – a large percentage of your organization’s success rests in the hands of the insurance industry in several different ways.

For all behavioral healthcare programs, understanding how to effectively get credentialing services should be a top priority. If left unaddressed, you can lose potential revenue and admissions. Why wait?

If you own a substance abuse recovery facility, and you’re interested in becoming one of the preferred healthcare providers for an insurance company, we strongly advise you take advantage of the following resource.

So get your bookmark ready, and keep reading for specific resources on best practices for how to get credentialed with insurance companies when you own a rehab facility!

Why The Credentialing Process Is a Pivotal Step for Your Drug Rehab

Naturally, one of the most important steps of running a successful rehab is ensuring insurance companies pay for client services at your treatment center or centers. If you don’t get paid, revenue suffers, and can ultimately threaten the success of your entire business.

If you run a substance abuse treatment facility the credentialing process is a critical, albeit time-consuming, task that should be at or near the top of your “most important things to do” list – especially if you’re among the growing number of behavioral healthcare providers opening new locations.

For the best possible results (in terms of both admits and revenue generated) learning the ins and outs of satisfying the requirements during the credentialing process is crucial.

What makes the credentialing process just as important as licensing and credentials for behavioral and substance abuse healthcare providers?

• If your treatment center (or even an affiliated private practice) wants to bill insurance companies, you must go through the credentialing process.
• Healthcare providers who aren’t credentialed risk losing thousands in revenue.
• It’s worth noting that the credentialing process is a time-intensive one that necessitates deliberate and painstaking efforts.
• Many healthcare providers leverage the power of credentialing services to help them satisfy the requirements to become an in-network provider.

What Is an In-Network Provider?

An in-network provider is a term used to describe healthcare providers who have successfully completed the credentialing process for any specific insurance company and also agreed on a contract and fee schedule for the covered services you offer.

Being an in-network provider means you’ve satisfied the following requirements:

• You’ve submitted the relevant paperwork that meets the needs of not only the insurance companies you’ve applied for but also the needs of the designated state in which you’re applying.
• Your organization has finalized the payor provider enrollment process and agreed on reimbursement rates.
• You’ve pledged to provide affordable quality healthcare to recipients of the insurance company you’re credentialed by.

Why Is Credentialing with an Insurance Company Difficult?

The act of getting credentialed for any number of healthcare providers, including substance abuse treatment facilities, isn’t, by its nature, overly difficult. However, the process for drug rehab healthcare providers is extremely meticulous, requiring a substantial amount of time and careful attention to detail.

You will deal directly with the insurance agency’s network provider services department. However, this isn’t a one-and-done process. This must be completed for each one of the insurance networks or insurance companies you wish to receive credentials from.

Most insurance networks require special documentation, and if the process isn’t completed to the exact specifications of the insurance company, it could result in a rejection.

It’s not uncommon for insurance companies to require a drug rehab facility to complete a time-consuming process for an application that takes 20+ hours. And remember – this must be completed for each of the insurance companies you deal with.

After finalizing the requirements by each of these insurance companies, you could potentially be faced with hundreds of hours of administrative and clerical work, not to mention the ongoing time dedicated to utilization review once your credentials have been accepted.

How to Get Credentialed with Insurance Companies: The Timeline for Approval

Most insurance companies give health services organizations that bill them between 30 and 90 days AFTER services rendered to submit a claim for a client. In the event the claim is rejected, it must be resubmitted. However, this does not reset the initial 30 to 90-day window.

Your substance abuse and behavioral health treatment facility could end up in a bind, facing difficulties with satisfying the time limit if you accept clients from insurance companies you haven’t received credentials from. Insurance companies will not accept claims from a rehab facility when they haven’t satisfied the requirements and have been accepted into the insurance company’s network.

The specified 90 days seems like a substantial amount of time. However, when you’re dealing with dozens of clients, the luxury of time is no longer on your side. Failing to adhere to a timely filing process requested by insurance companies means potentially never being paid for services rendered.

Understanding all of the above, even a simple missed step is something that no rehab can afford.

My Rehab Is Already Credentialed: That’s It, Right?

No, not quite. If you’ve managed to juggle and maintain the balance of attending to your clients and handling the requirements of an insurance panel, you’re hardly in the clear. Most of the major insurance companies, like United Healthcare and others, require substance abuse facilities to be credentialed every 1 to 3 years.

This also depends on the state you’re licensed in and the insurance companies or bodies you are dealing with. For example, Medicare requires credentialing every 5 years.

When you’re a mid-to-large-sized facility, you’re dealing with multiple insurance companies. This process can quickly become a revolving door of high-demand, high-stress administrative work that continuously repeats in an endless cycle.

For longstanding rehab facilities, the challenge isn’t the initial credentialing process – it’s managing the recertification process. Many healthcare providers are unaware of any lapse in certification until the denials of payment start rolling in.

What Are the Consequences of Failing to Meet the Requirements of Insurance Credentialing?

For most rehabs, there are a handful of major insurance panels that make up a significant portion of your client’s source of payment. Failing to meet the requirements of just one of these organizations can mean lost revenues for your substance abuse treatment facility.

When in-network providers allow their credentialing to lapse, your claims will easily pile up, and can then easily surpass the 90-day window allowed by most insurance panels. The first time you make this mistake, it’s a very real possibility that your facility will fail to generate the revenue needed to continue day-to-day operations.

Just one denial from a major insurance company can cost your rehab facility thousands of dollars each day. Multiply that by the number of clients that receive coverage from said insurance company, and the possible collateral damage from a simple error becomes clear.

The Credentialing Process for Mental Health Treatment Centers and Substance Abuse Rehabs

The following section is a basic outline of what’s required of any rehab to become credentialed with insurance companies. Keep in mind, that provider credentialing varies from state to state and is based on the company and form of healthcare coverage your clients receive.

Whether your facility accepts mental health-primary clients can also impact these considerations.

However, this provides a general idea of the different requirements:

• First, you must apply to obtain an NPI. This is a National Provider Identifier and is used to identify your specific facility throughout the credentialing process.
• Meeting the demands of this step in becoming credentialed with insurance companies generally requires your BCBA Certificate Number, EIN, BA License Number, or Taxonomy Code.
• This is usually the easiest part of the process and takes around 1 to 2 business days.
• You also must become a member of the Council for Affordable Quality Healthcare (CAQH). For this step, you’ll need employment history, references, a W9 form, BCBA Certificates, your education history, along additional specifics regarding your rehab facility.
• All of these documents should be placed into a single provider credentialing files location so that they can be easily accessed by your team for future usage and re-credentialing.

When Should My Facilities Start the Process?

If you’re a new rehab facility, becoming credentialed with insurance companies should be a top priority. Making a choice to serve in the addiction treatment space is a valiant one – but as with any other business, regardless of how noble the cause, the lifeblood of the operation requires steady revenue.

There’s no reason to take the steps for opening and owning a rehab facility if you’re not prepared to meet the financial needs your business requires. Becoming an in-network rehab facility takes anywhere between 90 to 120 days. In addition, as an in-network provider, your facility will potentially be required to make a 45-minute call to each client’s insurance provider as a follow-up.

Are There Services Available to Assist in the Credentialing Process?

For larger facilities, credentialing EMR software for rehabs can help to streamline the process. However, for smaller treatment facilities, the cost of creating a customized version of this software makes it an unrealistic expense.

Some of the larger billing companies offer credentialing as an additional package, which requires an additional payment to your monthly, quarterly, or yearly service. While these services can be valuable, they may not have the expert staff on hand to give you the dedicated services that you require.

Luckily, there are insurance credentialing services that can help make sure you meet the deadlines and your applications are precise and accurate – even when it’s time for you to reapply. Outsourced provider enrollment services are the ideal solution for all of your credentialing needs.

The Advantages of Outsourcing Your Credentialing Needs

The right credentialing service provider will be focused solely on your needs. The staff consists of experts in the field, providing facilities with things like an online dashboard to simplify the submission process.

All of your pertinent documentation is stored in a secured bank that’s also compliant with the demands of HIPAA. Most of these providers work with insurance agencies in every state and have boots-on-the-ground experience when it comes to handling unique situations.

An expert service will also conduct calls to each provider you deal with as an initial step, completing an audit that outlines your credentialing status as a whole. Calls are conducted on a company-to-company basis, eliminating the need to manually complete these calls and be placed on hold for at least an hour with each provider.

In addition, the right credentialing service will also keep track of when it’s time for you to reapply. You’ll be notified via phone call, email, and text when the dates approach so you and your teams will never miss another deadline.

Ads Up Marketing Offers Credentialing Support

At Ads Up Marketing, we have a team of substance abuse treatment experts who offer comprehensive services for any treatment facility. Our expert staff are fully licensed for addiction treatment marketing in Florida and work with centers from across the country every day. Behavioral health marketing is who we are, and our deep well of knowledge and experience can be yours.

Contact us now and schedule an initial consultation so we can help get your credentialing needs taken care of ASAP, so you never miss a payment and have a solid system in place for new providers and for re-credentialing as well!