Therapist & mental health credentialing
In network with the plans your clients use, on the earliest date each payer allows.
We credential LCSWs, LPCs, LMFTs, psychologists, psychiatrists and psychiatric NPs with Medicare, Medicaid, commercial plans and the behavioral health companies that run some plans’ networks, and follow each one to a written effective date.
- Price
- $189 per payer, less in bulk
- Medicare
- MFTs and MHCs since Jan 2024
- Plan for
- 90–120 days, by payer
- Who
- Therapists to psychiatrists
What’s different about credentialing a therapist
The steps are the same ones in our provider credentialing service: NPI, CAQH profile, payer applications and follow-up until each payer confirms an effective date. What changes for mental health providers is who can enroll, where each application goes, and which details reviewers check hardest.
Medicare is the biggest recent change. Section 4121 of the Consolidated Appropriations Act, 2023 created a Medicare benefit for marriage and family therapists and mental health counselors, and since January 1, 2024 both can enroll in Medicare and bill it directly. Counselors licensed as LPCs, LMHCs or LPCCs enroll as mental health counselors when they meet Medicare’s requirements, and so can qualifying addiction counselors.
- Who can enroll depends on license level, and associates still completing supervision usually cannot enroll on their own.
- The application does not always go to the plan on the client’s card. Some health plans contract behavioral health to a separate organization that keeps its own network and verifies the credentials of its own practitioners.
- Details get checked line by line: the NPPES taxonomy code, the license type, every state you see clients in, and each practice location.
Billing has its own rules too, from time-based psychotherapy codes to session limits: see psychiatry and behavioral health billing.
Which license levels can be credentialed
Medicare sets out its rules for each provider type in its mental health coverage booklet. Clinical psychologists must be licensed at the independent level. Clinical social workers, marriage and family therapists and mental health counselors need a master’s or doctoral degree, at least two years of supervised clinical experience after it (or 3,000 hours, for MFTs and MHCs) and a state license.
- Psychiatrists enroll as physicians, and psychiatric nurse practitioners as nurse practitioners.
- LCSWs enroll as clinical social workers.
- LPCs, LMHCs and LPCCs enroll as mental health counselors, and LMFTs as marriage and family therapists.
- Psychologists licensed for independent practice enroll as clinical psychologists.
- Associates and residents still completing supervision (LPC-A, LMFT Associate and similar titles) cannot enroll in Medicare on their own.
Medicaid and commercial plans set their own rules for associates. North Dakota Medicaid, for example, says Licensed Associate Professional Counselors may not bill under a supervising practitioner’s NPI for its behavioral health rehabilitative services. And Medicare does not cover services provided incident to a clinical social worker’s, MFT’s or counselor’s own services, so an owner in those fields cannot bill an associate’s Medicare sessions under the owner’s number.
Payer by payer: what to expect
Planning ranges with a complete application, the same ones on our main credentialing page. Every payer sets its own pace, so we track each to a written effective date.
- Documents and CAQH profile1 to 2 weeks, once the documents are in hand.
- Medicare (CMS-855I)30 to 90 days. MFTs and counselors whose license did not require the supervised hours document them with letters on letterhead.
- Medicare in more than one stateA separate enrollment for each state where you render services, with a license in each. Compact licenses count as full licenses.
- Medicaid30 to 90 days by state. Rules for associates and for backdating vary by state.
- Medicaid managed care plansPlan on 60 to 120 days after state enrollment. Each plan credentials you separately, and may contract with you for up to 120 days while state enrollment is pending.
- Medicaid behavioral health plansSome states use separate plans. Michigan contracts with regional plans to manage Medicaid specialty behavioral health and its provider network.
- Commercial plans and behavioral health companies60 to 120 days, plus 2 to 6 weeks to load the contract. Some panels are closed by specialty and area, so we confirm each is open first.
- Keeping it currentCAQH re-attestation every 120 days, Medicare revalidation every five years, re-credentialing on each plan’s cycle.
What credentialing costs
Priced per payer application, so you pay only for the enrollments you need. The more payers you add, the less each one costs.
Standard rate
$189per payer application.
Up to 7 payers
$150per payer application when you enroll with several payers at once.
Up to 20 payers
$120per payer application for a larger rollout.
Every application includes
- A CAQH ProView check and update
- The payer application, filed in that payer’s format
- Weekly payer follow-up until approval
- The effective date confirmed in writing
- EFT and ERA setup so payments arrive
- No setup fee
Each application covers one provider with one payer. Your price is confirmed in writing before we start.
Not enrolled means not paid.
A provider who isn’t credentialed can still see patients. They just can’t bill for them. Pick a start date and the payers you need to see where the gap falls.
Start credentialing the day you sign the contract, not the day your provider starts seeing patients.
Plan a new provider’s start
13weeks of visits could fall before an effective date
With a start in 1 month, Medicare could be effective in 30 to 90 days and commercial plans in 60 to 120.
Typical ranges with a complete application; commercial plans can need 2 to 6 more weeks to load the contract. Each payer sets its own pace, so we track every application to an effective date in writing.
Start credentialingNPI, taxonomy and group details to get right
These details have to match across NPPES, CAQH and every application. We check each one before anything is filed:
- Taxonomy code. In the NUCC code set, 1041C0700X is a social worker licensed at the clinical level; the general social worker code, 104100000X, does not specify a clinical license. Counselors have 101YM0800X (mental health) and 101YP2500X (professional), MFTs 106H00000X, clinical psychologists 103TC0700X, psychiatrists 2084P0800X and psychiatric NPs 363LP0808X. Medicare’s FAQ gives 101YM0800X for counselors.
- One individual NPI. A clinician can hold only one individual (Type 1) NPI and uses the same one with every payer.
- Group enrollment. A group enrolls in Medicare on the CMS-855B, and each clinician reassigns benefits to it on the CMS-855I.
- New clinicians in a group. Each is credentialed individually by every payer, then added to the group’s roster. The group contract alone does not put a new clinician in network.
Moving from solo practice into a group, or opening your own? We file the group enrollment first so each clinician’s reassignment has somewhere to go.
How we credential a therapist or a group
License and payer review
We confirm each clinician’s license level and states, build the payer list from your client mix, and check which panels are open and who manages each plan’s behavioral health.
NPPES and CAQH
We fix taxonomy codes and practice locations in NPPES, then build or clean the CAQH profile, attest it and authorize every target payer.
Applications in the right order
Group enrollment first where there is one, then Medicare, state Medicaid, each Medicaid plan, and the commercial and behavioral health networks in priority order.
Weekly follow-up
Payer calls and portal checks every week, requests answered inside their deadline (30 days for Medicare), and a live status tracker.
Dates, payments and renewals
Effective dates confirmed in writing, EFT and ERA set up, and CAQH, revalidation and re-credentialing dates on a calendar we watch.
What we need from each clinician
One clean handoff and we take it from there:
- Individual NPI, and group NPI if any
- State license for every state served
- Proof of supervised hours, if asked
- Malpractice certificate of insurance
- CV with a gap-free work history
- Degree, and board certificate if any
- DEA and state CDS (prescribers)
- Tax ID / EIN and practice locations
- Voided check for EFT enrollment
Questions therapists ask
Something else? Call +1 786-788-7313 and a credentialing specialist answers.
All questionsYes. Since January 1, 2024, licensed marriage and family therapists and mental health counselors can enroll in Medicare and bill it directly, alongside clinical social workers, clinical psychologists, psychiatrists and psychiatric nurse practitioners. LPCs, LMHCs and LPCCs enroll as mental health counselors if they meet Medicare’s requirements. Enrollment is on the CMS-855I, and Medicare pays MFTs and counselors 75% of what it pays a clinical psychologist.
Usually not on their own. Medicare requires a state license and completed post-degree supervised experience for clinical social workers, MFTs and mental health counselors, and an independent-level license for clinical psychologists. Some state Medicaid programs and commercial plans have their own rules for supervised clinicians, and those rules differ, so we check each payer’s written policy before an associate sees its members.
Because some health plans contract their behavioral health benefits to a separate organization that runs its own network and credentials its own practitioners. When a plan works that way, an application to the medical side does not put you in its behavioral health network, and some state Medicaid programs work the same way. Our eligibility and benefits checks show who manages a client’s behavioral health benefits before the first session.
Plan on 90 to 120 days for a full set of payers. Medicare and state Medicaid usually take 30 to 90 days; commercial plans and behavioral health companies take 60 to 120 days, plus 2 to 6 weeks to load the contract. Our credentialing timeline guide has the payer-by-payer detail and the effective-date rules.
The clinician is credentialed individually with each payer, then linked to your group. For Medicare, the clinician reassigns benefits to the group on the CMS-855I and gets a new Medicare number linked to it; the group’s own number does not change. Commercial and behavioral health networks add the clinician to your roster once approved. Start 90 to 120 days before the first session.
It is $189 per payer application, or $150 per payer for up to 7 payers and $120 per payer for up to 20, with no setup fee. Each application covers one clinician with one payer and includes the CAQH check, weekly follow-up, the effective date in writing and EFT and ERA setup. For a group, multiply clinicians by payers; we confirm the total in writing first.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
Get credentialed with insurance
Every step from NPI to a loaded contract, in the order that saves weeks, with what goes wrong at each one and how to keep it from happening to your file.
How long does credentialing take?
Credentialing times by payer, the rules that set your effective date, and a 120-day plan that keeps a new provider from seeing patients you cannot bill for.
Specialties we credential
Adding a therapist or opening a group?
Send us each clinician’s license and the payers you want. We’ll tell you who can enroll now, where each application goes and which effective dates are realistic.