Mental & Behavioral Health Therapists FAQ
Insurance Credentialing & Practice Options
1. Do I need a business entity to credential with insurance companies?
Yes. Most payers require you to have a legally registered business (LLC, PLLC, or PC) with an EIN and a Type 2 NPI (for your business). You’ll also need your individual Type 1 NPI. Both your business and your provider profile are credentialed, which keeps your personal and business information separate and offers legal protection.
2. Can I credential under just my individual NPI?
No. Nearly all payers now require both your business entity (Type 2 NPI) and your individual Type 1 NPI. This is a critical step to being approved for in-network participation.
3. How do reimbursement rates compare if I join a platform like Headway or Alma?
Platforms like Headway and Alma often negotiate higher rates because they contract on behalf of hundreds of providers. As a solo provider, you’ll usually receive the payer’s standard fee schedule, which may be lower.
4. Will I know the reimbursement rates before signing?
Not in advance. Rates are disclosed only when a payer issues a contract. If you decline, you will not be credentialed with that plan. A common strategy is to accept initial rates and then renegotiate at renewal once you have patient volume and billing history. Commercial payers typically pay 80–120% of Medicare’s Fee Schedule, depending on specialty and location.
5. Can I negotiate rates upfront?
Generally, no. Payers rarely negotiate rates during initial credentialing, especially with independent behavioral health providers. Negotiation opportunities arise at contract renewal once you have utilization data.
6. Am I guaranteed a contract once I apply?
No. Payers may close networks if they believe they already have enough providers in your area, or if your license type isn’t currently being enrolled. Unfortunately, this is often only disclosed after your application is submitted.
7. How long does the credentialing process take?
- Medicare: ~30–45 days
- Commercial/Private Insurance: ~90–120 days on average (can be longer depending on payer backlog)
TRIUMPHEALTH monitors and follows up with payers consistently to help move the process forward.
8. What are the benefits of using a platform like Headway or Alma?
- They handle credentialing, billing, and collections.
- You can see clients immediately without upfront costs.
- The trade-off: they take a percentage of your reimbursement and you don’t own the contracts.
9. If I credential independently will I earn more?
It depends. You’ll keep 100% of your reimbursement, but:
- Your starting rates may be lower.
- You’ll carry costs for credentialing, billing software, and admin support.
- You may experience several months without insurance income while waiting for credentialing approvals.
10. Can I bill insurance as a sole proprietor?
Most payers require a legal entity (LLC/PLLC/PC) with an EIN. A few may accept sole proprietors, but this limits your ability to expand or hire later. For liability reasons, TriumpHealth does not credential sole proprietors.
11. How much does TriumpHealth charge for credentialing?
TriumpHealth charges per payer application. Fees cover the credentialing process itself but do not guarantee payer approval, since acceptance depends on payer network status and requirements.
12. What should I consider before leaving Headway or Alma to go independent?
- Independent credentialing gives you long-term ownership of contracts and full control.
- Startup costs and credentialing timelines mean you may face 3–4 months without insurance reimbursement.
- Platforms offer immediate patient access, but at the cost of lower autonomy and reduced reimbursement due to platform fees.
If you’re ready to take ownership of your credentialing and contracts, TriumpHealth can help manage the process and guide you through setup, applications, and payer follow-ups. You can reach us at [email protected] or call (888) 747-3836 x0.
Disclaimer:
The content provided by TriumpHealth is for informational purposes only and does not constitute legal, medical, or financial advice. Regulations and payer requirements may change; please consult a qualified professional for guidance specific to your situation. Click here to review our full legal disclaimer.
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