Navigating the mental health credentialing, health plan, and enrollment process requires strong organization and attention to detail. This checklist provides a quick, high-level guide to ensure you have everything in place for your practice’s success.

Licensure

  • Is Your License Active? Before you can begin credentialing, ensure your license is active and up-to-date. Confirm that all state requirements are met.
  • What Type of License Do You Have? Make sure your license type aligns with your intended practice (e.g., psychologist, LCSW, LPC).
  • Have You Verified Your Continuing Education Credits? Make sure all continuing education credits are completed and recorded, as required by your state board.
  • Have You Established Your Legal Entity? Make sure your LLC, S-Corp, or sole proprietorship is legally recognized.
  • Do You Have All Necessary Documentation? Ensure you have your filing paperwork, operating agreements, and any other documents that verify your legal entity.
  • Is Your Business Registered with the State? Confirm that your business is registered with your state and that you have all necessary permits.

Tax ID and Bank Account

  • Have You Obtained Your EIN? This is essential for tax purposes and will be needed for credentialing.
  • Is Your Bank Account Set Up? Make sure your business bank account is established under your practice’s legal name.
  • Do You Have a Voided Check or Bank Letter? These are often required for Electronic Funds Transfer (EFT) setup with payors.

Insurance

  • Do You Have Professional Liability Insurance? Most payors require proof of this before you can be credentialed.
  • Have You Verified Coverage Amounts? Make sure your coverage meets or exceeds the requirements set by the insurance companies you plan to work with.
  • Is Your General Liability Insurance in Place? Although not always required for credentialing, it’s important for your business operations.

Register with Key Systems

  • Have You Created Your I&A Account? This is necessary to access other CMS systems like NPPES and PECOS.
  • Is Your NPI Assigned and Verified? Ensure both your individual (Type 1) and organizational (Type 2) NPIs are correct and active.
  • Do You Have Access to PECOS? If you plan on enrolling with Medicare, PECOS access is essential.

Documents for Credentialing

  • Do You Have All Required Documentation? Gather all necessary documents, such as licenses, diplomas, DEA certificates, insurance policies, and W-9 forms.
  • Are Your Documents Accurate and Up-to-Date? Double-check for accuracy; even small errors can delay the process.
  • Have You Organized Your Documents? Keep digital copies in a secure, accessible location for easy upload during the credentialing process.

Payor Selection

  • Are You Going to Handle Credentialing Yourself or Outsource It? Decide whether you will manage this process in-house or use a credentialing service.
  • Which Payors Best Fit Your Practice? Consider factors like reimbursement rates, patient demographics, and administrative ease.
  • Are You Ready to Submit Your Credentialing Applications? Once your payors are selected, prepare your applications for submission.

Submitting Credentialing Applications

  • Is Everything Prepared for Submission? Double-check that all fields are completed, and documents are attached.
  • Do You Have a Tracking System in Place? Keep track of submissions, follow-up deadlines, and responses from payors.
  • Have You Set Reminders for Follow-Ups? Stay on top of your applications by scheduling regular follow-ups.

Contracting

  • Do You Understand the Contract Terms? Review contracts carefully, noting reimbursement rates, network participation, and any obligations.
  • Are You Ready to Negotiate if Necessary? Be prepared to discuss terms if something doesn’t align with your practice goals.
  • Do You Have Legal Support? Consider consulting a healthcare attorney to review contracts before signing.

Billing Setup

  • Have You Chosen a Billing System? Decide on a billing software that integrates with your EHR and handles claims efficiently.
  • Is Your EFT Setup with All Payors? Ensure that your bank information is linked for direct deposit of reimbursements.
  • Are You Ready to Handle Claims Submissions? Set up a process for submitting and tracking claims, including handling denials and resubmissions.

Final Steps

  • Are You Ready to Go Live? Once all systems are in place, and credentialing is complete, confirm that your practice is ready to start seeing patients.
  • Have You Considered Ongoing Support? Determine whether you’ll need continued support from a credentialing service or legal advisor as your practice grows.

This checklist is your roadmap to a smooth credentialing and billing process. For a deeper dive into each step and additional expert advice, be sure to download The Complete Guide to Credentialing and Billing for Mental Health Practices from pie Health.

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