Credentialing Software Solves Hurdles Faced by Behavioral Health Industry

More than 50 percent of adults in the United States reported mental health difficulties related to the pandemic, according to a poll conducted by the Kaiser Family Foundation poll. Unfortunately, the increase in demand is outpacing the availability of behavioral health providers that are in-network with many of the major insurance companies.

Experts estimate that approximately 90 percent of insurance network applications for therapists and counselors are denied.

This is not the fault of the provider, since federal law requires insurance companies to offer the same benefits for behavioral health as they offer for physical health. Furthermore, SAMHSA is working to advance efforts that recognize behavioral health as essential to physical health, improve access to services, while developing financing mechanisms to support positive client outcomes.

While a patient’s co-pay for behavioral health services may be the same, there is still no guarantee patients can find a therapist in-network with their insurance plan and located close to them.

Experts say the most frequent reason therapists are given for the rejection of their application is that the insurance network in their area is full. It is often in the best interest of the insurance company to have the smallest number of in-network behavioral health providers possible.

While it may seem financially counterproductive to limit patient access to mental health services and receive fewer co-pays, the opposite is true. Smaller networks mean lower administrative costs, and each behavioral health provider a plan adds to a network costs the health plan money. There is the cost of entering healthcare provider data into multiple forms, provider contract management, provider data management, provider credentialing, and other associated healthcare administrative costs.

To make matters worse, the time required by behavioral healthcare professionals for credentialing is up to five times greater than for traditional healthcare providers due to nuances specific to the industry.

Medical Credentialing Software as a Service Solutions

Since many behavioral health providers work in a private practice, it is up to them to meet credentialing and state licensure requirements while balancing enrollment with health insurance plans if they are eligible. Due to the strict privacy regulations concerning mental health services, many of these healthcare administrative tasks cannot be outsourced nor would it be financially beneficial to do so. An all-in-one, free medical credentialing software is an ideal solution for behavioral health providers. In additional to managing medical credentials, the software as a service (SaaS) offers automated payer enrollment, alerts for expiring credentials such as medical licenses, continuing medical education (CME) courses, OIG Exclusion List monitoring, and HIPAA-compliant communication tools.