[MUSIC PLAYING] Welcome. This lesson is about insurance and EAP, or employee assistance programs credentialing. Becoming paneled with insurance companies and EAPs is not necessary, but it is highly advised for anyone wanting to establish a lucrative counseling practice. Almost all clients with insurance will desire to use their insurance as a form of payment for counseling. So in this lesson, we'll cover the following-- reasons for credentialing, requirements for credentialing, CAQH ProView, alternatives to CAQH.
Being credentialed with insurance companies provides a referral source for clientele, and it's an avenue toward financial stability. You'll spend much less time and money on marketing and worrying about client referrals if you allow the insurance companies to handle that for you. Sure, you can charge more for out-of-pocket paying clients, but those are not easy to come by, and the less amount that you may receive from insurance reimbursement is most often worth the lack of energy you'll have to put into getting clients on your own.
Credentialing is the process that you go through to get paneled. An insurance panel is a group of practitioners that the insurance company covers. Requirements to be credentialed with an insurance company vary across insurance companies and EAPs. Research to determine which insurance companies and EAPs are local and have open panels. So an open panel can be defined as an insurance company that is currently accepting applications for clinicians to be in the insurance company's network.
Common requirements include, an independent license, although some panels except non-independent license individuals; liability insurance; a tax ID; an NPI number; a completed CAQH application or insurance-specific application; an attestation that you are fit to practice without pending charges or claims made against your license.
So it's not mandatory to complete a CAQH application, but it is advised. The CAQH system can be found at this website. A CAQH application ultimately saves you time and paperwork. You must have college transcripts, a résumé, references, a counseling license, liability insurance, a TIN, or tax identification number, and type 1 NPI in order to fill out a CAQH application. So it will take a few hours to fill out a CAQH application, and it will be important to collect all of that information before you start the process. And this all will be completed online.
Now a CAQH application is free to fill out, but you must either be invited by an insurance company in order to log into the system, or you can create your own account at the CAQH website. A counselor can be invited to the CAQH system by calling the credentialing department of an insurance company and asking the credentialing specialist if he or she can provide a CAQH invite. Counselors have to attest or confirm that their information is current and correct within the CAQH system every 120 days. Now you can do all of this on your own, or you can pay a credentialer to complete the process. Once the application is accepted and complete, you can authorize any insurance company, or EAP, or specific insurance companies and EAPs to access the application in order to credential you.
Now even though you authorize insurance companies and EAPs' access to your application, the authorization does not mean that any specific insurance or EAP company will simply access that application. Go to each insurance company and EAP website, find the "for providers" section and look for the credentialing information. Follow the directions found under the credentialing information section. Now typically, this will include filling out a brief inquiry and submitting it online.
And this inquiry starts the process of credentialing if the insurance company is currently open and paneling counselors. So it's important to note here that there are time frames in place for insurance companies to respond to your inquiry. So listen up here-- save all of your paperwork. If you don't have a response within the stated time frame, contact the insurance credentialing department.
There is no alternative to CAQH if a counselor wants to be paneled on most of the national insurance companies. CAQH is it. Smaller insurance companies, or EAPs may not use the CAQH system. And if that's the case, fill out a paper application by hand with the same information and details needed for a CAQH application or complete the insurance company or EAP's application on the company's commercial website.
An alternative to being credentialed is only taking cash-paying clients. Note that if more of the client population gets health care, the prevalence of self-pay will be decreasing. So keep in mind that nonprofit organizations can apply for grants to help finance counseling services. Individuals, businesses, and nonprofit organizations can apply for a contract with their state department human services council. State contract applications have a similar requirement as the CAQH application. In this lesson, we covered the following-- reasons for credentialing, requirements for credentialing, CAQH ProView, alternatives to CAQH.
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Overview:
(00:00-00:45) Introduction
(00:46-01:21) Reasons for credentialing
(01:22-02:30) Requirements for credentialing
(02:31-05:15) CAQH Proview
(05:16-06:23) Alternatives to CAQH
(06:34-06:45) Summary