Insurance credentialing, explained.
Getting paneled with insurance is one of the most time-consuming parts of starting a behavioral health practice. These guides cover what you actually need to know — from your first NPI number to choosing which networks are worth your time.
How credentialing works
How long does insurance credentialing take for therapists?
Typical credentialing timelines by payer (60–150 days), why committee cycles add weeks, and the contract and claims loading phase most therapists forget.
Insurance credentialing checklist for therapists
The full pre-submission checklist: license, NPI taxonomy, name-match traps, malpractice dates, CAQH attestation, organized by phase, ready to copy and run.
Which insurance panels should therapists join?
How to pick your first payers: the four majors and their 90837 rates, Optum's closed metro panels, Headway vs. direct, and Medicare for LMFTs and MHCs.
By insurance network
Requirements, reimbursement rates, and whether each payer is worth it for your practice.
Medicare enrollment for LMFTs and LMHCs: PECOS, rates, and the opt-out trap
LMFTs and mental health counselors can bill Medicare since 2024. The PECOS steps, 2026 rates for 90834/90837, and the participating vs opt-out dollar math.
Blue Cross Blue Shield credentialing for therapists: find your state's Blue
BCBS is 33 independent companies, not one payer. Find your state's Blue licensee, where to apply (usually Availity), and the rejections that stall therapists.
Aetna credentialing for therapists: the two letters to expect
How Aetna credentials therapists: the Request for Participation form, the 45-day network-need decision, CAQH verification, and returned applications.
Anthem credentialing for therapists: first check it's your Blue
Anthem is the Blue Cross Blue Shield plan in only 14 states. How to tell if Anthem is your Blue, apply through Availity, and survive the 90-120 day review.
Cigna credentialing for therapists: it's Evernorth, and watch the EAP clause
Cigna credentials therapists through Evernorth Behavioral Health. The Provider Information Form, the 90-day timeline, and the EAP surprise in the contract.
UnitedHealthcare credentialing for therapists: expect the closed panel
UHC therapists credential through Optum Behavioral Health, where closed panels are the norm. How to apply, appeal a denial, and dodge the Optum Pay fee.
CAQH, NPI, and paperwork
The CAQH 120-day attestation rule: what breaks when your profile goes stale
CAQH attestation expires every 120 days. What actually freezes when it lapses, the 7 profile mistakes that stall credentialing, and a quarterly fix.
NPI numbers for therapists: Type 1, Type 2, and what your PLLC changes
Every therapist who bills insurance needs a Type 1 NPI, and if you bill under an LLC or PLLC, a Type 2 as well. How to register on NPPES and what must match.
What is CAQH and how do you set it up?
CAQH ProView is the shared credentialing database Aetna, Anthem, Cigna, and UHC all pull from. How to register, upload documents, authorize payers, and attest.
Mid-process: stalls, denials, and follow-up
Credentialing follow-up scripts: exactly what to say on every call
Word-for-word phone and email scripts for chasing a credentialing application: the cadence, what to log, and each major payer's contact path.
Recredentialing for therapists: the 3-year cycle that fails silently
Payers recredential every 2-3 years, and a missed packet or stale CAQH can terminate you without warning. What to verify at 6, 3, and 1 months out.
Credentialing application denied: what it means and how to fix it
Most credentialing denials are fixable data problems, not judgments. The 8 real causes, denial vs closed panel vs lost application, and the exact fixes.
How to bill insurance after credentialing: your EHR does most of it
Billing is the easy part. How SimplePractice, TherapyNotes, and other EHRs create, submit, and track insurance claims, plus the setup that makes it work.
Can you bill insurance before credentialing is complete?
Mostly no: claims before your effective date deny, and most commercial payers won't backdate. What actually works while you wait, payer by payer.
How to appeal a closed insurance panel (appeal letter template included)
Panel closed doesn't mean no. How therapists appeal a closed insurance panel with a network-adequacy exception request, plus a fill-in letter template.
Rates, money, and the insurance decision
How to become an EAP provider (and whether it's worth it)
How therapists join EAP networks like Optum EAP, ComPsych, Lyra, and Spring Health: application paths, typical rates, and the 30-90 day credentialing.
Insurance vs. private pay: the break-even math for a therapy practice
Private pay averages $159 a session, insurance $111, but empty slots decide which model wins. A break-even framework with a worked example and worksheet.
How to negotiate insurance reimbursement rates as a therapist
When therapists actually have leverage to negotiate rates, how to anchor asks to Medicare percentages, which CPT codes to target, and a letter template.
Superbill template for therapists (every required field, explained)
The exact fields a therapy superbill needs: NPI, taxonomy, CPT, ICD-10, POS, license number, plus a copyable template and a client email blurb.
Headway and Alma vs. getting credentialed yourself: the real trade
Platforms panel you in weeks but hold the payer contract and set your rate. What Headway, Alma, Grow, and Rula actually trade you, and when each path wins.
Therapy reimbursement rates by insurance: what each payer actually pays
What Aetna, Anthem, Cigna, and UnitedHealthcare pay for 90837, 90834, and 90791, with Medicare and Medicaid benchmarks and how to read a fee schedule.
Practice setup
Type 2 NPI and billing under an LLC: keep claims paying after you incorporate
Type 1 vs Type 2 NPI in plain English, the single-member LLC surprise, what goes on the W-9, and how to switch payers to your LLC without breaking claims.
Group practice credentialing: contracts, Type 2 NPIs, and adding clinicians
How group credentialing actually works: group contract vs individual links, Type 2 NPI and EIN setup, the 90-day new-hire head start, and a roster tracker.
Ready to get paneled?
Pick your panels and we'll start today — no calls, no meetings.