Fast Track or Dead End? What Every Therapist Should Know Before Joining Headway

You’re launching your own practice. You know how to care for patients, but now you need to get paid.

Maybe you’re coming from a group or hospital. Maybe you’ve been seeing clients as a W-2 but are finally ready to start your own practice.

You look around, and the first offers you see are from companies like Headway, Alma, or Grow Therapy. They say they’ll handle insurance credentialing for you. They’ll even send you patients.

It sounds perfect: quick credentialing, getting paid fast, referrals delivered to your inbox. What’s not to love?

But is it too good to be true?

Behind that offer is something called delegated credentialing. It lets you start quickly, but that speed comes with tradeoffs.

We’ve worked with dozens of providers who started with one of these platforms and later tried to go independent. Some made the jump successfully. Others ran into delays, restrictions, or lost months of income in the transition.

This article walks you through what delegated credentialing really is, how it works, and what to think about before you build your practice around it.

At pie Health, we focus on non-delegated credentialing for independent providers and groups, so we naturally favor models that preserve long-term autonomy.

While this article focuses on behavioral health, similar delegated models exist in other specialties—often through large group practices, MSOs, or telehealth platforms.

How Delegated Credentialing Works

In a delegated model, a payer gives another organization the authority to credential providers on its behalf, following standards established by organizations like the National Committee for Quality Assurance (NCQA) and the National Association Medical Staff Services (NAMSS).

The delegated entity—often a company like Headway, Alma, or a large telehealth group, group practice, or hospital system—verifies qualifications, manages documentation, and submits provider rosters to the payer. The payer then enrolls those providers based on that internal process, rather than reviewing each one individually.

This saves time. Credentialing can take as little as 30 to 45 days. Delegated groups also often provide infrastructure such as referrals, billing support, or platform tools that make it easier for providers to ramp up quickly.

That early momentum is exactly what draws many providers, and even entire groups, into delegated credentialing.

Why Providers and Groups Choose Delegation

Delegated credentialing has strong advantages, especially for high-volume organizations:

• Fast onboarding: 30 to 45 days versus 90 to 160 days for traditional credentialing
• Less paperwork: delegated staff handle documentation and verification
• Operational simplicity: credentialing is standardized across providers
• Earlier revenue: providers see patients and submit claims faster
• Patient referrals: many delegated groups promise to help fill caseloads
• Scalable growth: ideal for groups adding 10 or more providers regularly

Industry research supports these benefits. For example, a 2023 study cited in HealthLeaders Media found that credentialing delays cost organizations an average of $9,000 in lost revenue per provider per month. Accreditation bodies such as NCQA note that delegation can dramatically reduce administrative overhead and speed up provider onboarding.

But faster doesn’t always mean better, and scale often comes with strings.

If you’re trying to decide whether to join a platform or go your own way, it can help to see how both paths play out in real life.

Delegated vs. Non-Delegated: Two Providers, Two Very Different Journeys

Erin M. and Dante L. are composite examples of licensed professional counselors (LPCs) in Pennsylvania who launched solo private practices in early 2023. They represent providers with similar training, patient populations, and markets whose credentialing paths—and results—were very different.

The following profiles are composites based on multiple providers we’ve worked with. Names and some details have been changed for clarity.

Month 0–1: Erin signs up with Headway, which promises to handle all payer paperwork and provide early patient referrals.

Month 2–4: She’s in-network with Aetna, Cigna, and Highmark BCBS under Headway’s TIN. She averages 6–8 weekly 90837 sessions at $70–$85/session. Revenue starts around $1,200/week.

Month 5–7: Referrals slow. She adjusts availability and tries new client engagement tactics. She asks about Medicaid and is told it’s unsupported.

Month 8: Erin feels stuck. She wants to bill under her own TIN, control her rates, and add another provider—but she’s told she’ll need to start over.

Month 9: She initiates her exit, complies with a 90-day clause, and begins preparing for direct credentialing.

Month 10–12: She reapplies to Aetna, Cigna, and Keystone First as an independent. With no carryover, she’s treated as a new applicant. Her expansion plans are put on hold.

Revenue Impact: The transition stalls her earnings. She estimates a $15,000 opportunity cost in lost income, delayed billing, and time spent rebuilding referrals.

“I didn’t realize how much I’d given up until I tried to build something of my own.”
—Erin, composite provider example

Erin’s reimbursement rates are based on Headway’s negotiated contracts. In most cases, individual providers cannot negotiate these rates directly. Use Fair Health Consumer to look up typical reimbursement rates for 60-minute psychotherapy (CPT 90837) in your area.

Month 0–1: Dante opens his practice and hires a credentialing firm to help apply directly with Aetna, Cigna, Highmark BCBS, and Keystone First.

Month 1–3: He sees a few cash-pay clients weekly, offering discounted 90791 and 90834 sessions. He learns how to manage his billing and starts networking locally.

Month 4–6: Approvals start rolling in. By month six, he’s credentialed with two commercial plans and Medicaid. In this example, he sees 12–15 clients weekly at $90–$110 per session.

Month 7–12: He renegotiates one contract based on volume and retention. He scales to 18–20 sessions weekly, brings in around $8,000 per month in this scenario, and begins planning to hire.

Month 13: Dante engages a billing service to manage claims, while continuing to use his credentialing firm for network expansion.

“It took longer upfront, but now I own the entire process. I’m building for the long haul.”
—Dante, composite provider example

Note: Dante’s rates reflect direct payer contracts. While limited at first, providers may renegotiate after 12+ months based on patient volume and outcomes. See MDClarity for more.

Side-by-Side Comparison (Example)

Here’s an illustrative comparison of how a delegated vs. non-delegated path can play out for providers like Erin and Dante; your actual results will vary depending on your payers, market, and caseload.

Credentialing timelines and requirements are based on guidance from NAMSS and NCQA.

The TikTok Game That Explains It All

There’s a viral TikTok challenge called the Speed vs. Strategy Cup Game where two people race to collect cups or discs spread out across a field. One starts with the closest and works outward. The other starts at the farthest point and moves back in. Every time, the one who starts furthest out wins.

Delegated credentialing feels like grabbing the closest cup: fast, easy, satisfying. But once you try to shift direction—whether it’s billing, growth, or control—the rest of the distance starts to catch up with you.

Direct credentialing takes longer up front. It’s the long walk to the furthest cup. But every step brings you closer to full autonomy and momentum that’s yours to keep.

What About Medicaid and Medicare?

Both Erin and Dante hoped to eventually serve clients with Medicaid and Medicare. But their credentialing paths had very different implications when it came to government payers.

Government payers introduce an added wrinkle to the credentialing decision, one that many providers overlook until they’ve already signed on.

Many delegated arrangements therapists encounter are with commercial insurers. Medicare, Medicaid, and TRICARE generally require providers to complete their own enrollment steps, as outlined by NAMSS and federal guidance. That means even if you’re delegated with Aetna or Cigna, you’ll still need to apply separately for government payers.

That means even if you’re delegated with Aetna or Cigna, you’ll still need to apply the traditional way for government payers.

Erin didn’t find this out until months into her work with the platform. Dante knew going in and factored Medicaid enrollment into his credentialing strategy.

And government access isn’t the only concern. How credentialing is handled, and by whom, can impact your risk long after the contract is signed.

Who’s on the Hook for Compliance?

Beyond eligibility, there’s another major consideration: who’s accountable for getting credentialing right.

Delegated groups are responsible for credentialing every provider under their umbrella. That means regular audits by payers, recredentialing schedules, and documentation standards set by organizations such as NCQA and URAC.

Providers rarely see this process, but they’re affected by it. If the delegated group fails an audit, misses documentation, or falls behind on recredentialing, the payer can suspend or revoke network access for the entire group. Contracts can be pulled with little notice, leaving providers like Erin suddenly out-of-network through no fault of their own.

That’s the part Erin didn’t fully understand when she joined. Her billing was simple and her credentialing felt invisible. But it also meant she had no visibility or control. At one point, an audit issue with a commercial payer led to problems with her group’s contract, and her claims started bouncing. The delegated group eventually resolved it, but Erin spent weeks unsure if she’d be reimbursed or whether she should stop seeing certain clients altogether.

Dante, by contrast, is credentialed directly with each payer. His paperwork and deadlines are his to manage, and if something’s missing, the payer contacts him or his credentialing team directly. He’s not at risk because of another provider’s file or a group’s internal process.

The tradeoff is more work up front, but greater independence—and fewer surprises later.

For providers building a long-term business, these risks can become liabilities. And if you’re not asking the right questions up front, they’re easy to miss.

Questions to Ask Before You Sign with a Delegated Entity

If you’re considering a platform or group that uses delegated credentialing, ask:

• Will I be credentialed under your TIN or mine?
• Can I bill payers directly if I choose to?
• What happens if I want to leave?
• Will you issue a release letter if I request it?
• How are patients matched to me?
• What’s the average number of referrals in my zip code and license type?
• How often are you audited by payers? Have you ever failed an audit?
• Do you support Medicaid or Medicare enrollment?

If they can’t—or won’t—answer these questions clearly, take that seriously.

Want help avoiding the common credentialing mistakes providers make when switching from delegated to direct? Read our guide to credentialing best practices for actionable tips before you lock yourself in.

And no matter what model you choose, it helps to keep one key idea in mind.

What to Ask a Non-Delegated Credentialing Partner

If you’re working with a credentialing firm or consultant (instead of a delegated group), the risks may be different—but the need for accountability is just as real. Ask:

• Who submits the applications—me or you?
• How do I track the status of my enrollments?
• What happens if a payer denies or stalls my application?
• How often will you update me on progress?
• Do you support recredentialing and Medicaid/Medicare?

Dante didn’t have the same compliance exposure as Erin, but he still had to ask the right questions when hiring his credentialing partner—and doing so made all the difference in how smooth his first year went.

For more tips, read our guide to working with a credentialing partner.

A Real-World Scenario: What It’s Like to Leave Headway

Details are anonymized to protect the provider’s identity.

One provider we worked with came to us to get paneled with Medicare and Medicaid. They also wanted to grow their group and bring on new providers. At the time, they were credentialed through Headway and had already built a strong caseload using the platform.

They were able to leave one commercial payor easily. “Aetna wasn’t an issue,” they said. But another commercial payor, which made up roughly 75% of their caseload, wouldn’t allow them to enroll under their own Tax ID unless they could get a release letter from Headway. “They told me they needed a letter of authorization from Headway. Headway said no.”

Headway refused to provide the letter. This matched what other providers have told us they experienced. But it put the provider in a difficult position. To move forward, they’d have to initiate a depaneling. “I was told it takes 30 to 60 days. And during that time, I wouldn’t be able to get paid by Headway for any of my clients with that payor.”

They tried to get clarity, but it wasn’t easy. “I actually got someone on the phone, which never happens,” the provider said. “It’s not like you can just call support and talk to someone. Most of the time, you’re stuck waiting for email replies that don’t answer your questions.”

The provider called the payor directly. They were told it might still be possible to bill directly, even during the transition. But that assurance didn’t bring much confidence. “I’m not in a position to go without the ability to get reimbursed for 1 to 2 months,” they said. “It’s 75% of my caseload.”

Even with responses from both Headway and the payor, the story didn’t add up. “Even if Headway says one thing and the payor says something else, it doesn’t mean I can bank on it.”

Headway’s patient protections became another barrier. Clients who found the provider through Headway had to stay on the platform. If the provider wanted to leave, those patients couldn’t follow, even if they wanted to. “They gave me a ton of referrals early on. It was great at first. But I had to turn it off. I couldn’t handle more.”

What started as a fast track to growth later created friction when they wanted to change directions. “Leaving can become extremely difficult if most of your caseload comes through the platform. I wish I’d known this from the start.”

Final Takeaway: Choose the Right Road

Platforms like Headway, Alma, and Grow Therapy can offer a tempting shortcut. The early speed, structure, and support are real, and for some providers—especially in the earliest phase of practice—they’re exactly what’s needed.

But short-term momentum doesn’t always set you up for long-term growth. If you choose a delegated path without thinking ahead, you may find yourself stuck on a road that doesn’t lead where you want to go.

So before you take the fast track, ask yourself: is this route getting me closer to my destination or just helping me move faster right now?

For providers who want full control, flexibility, and the ability to grow on their own terms, the direct route may be slower at first but it puts you in the driver’s seat for everything that comes next.

It’s your journey. Choose the road that leads to the practice you actually want to build.