info@mentalhealthbillingservice.com
Mental Health Billing Services (MHBS) operates credentialing practices built around one discipline. Behavioral health. Enrollment closes in 60 to 90 days. Parallel application submission trims 4 to 8 weeks off the sequential timeline..
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Mental health credentialing services translate a clinician’s license, training, and history into a payer-ready file that survives a credentialing committee. Behavioral health credentialing covers NPI registration through NPPES alongside CAQH ProView setup with the 120-day re-attestation cycle.
Medicare PECOS enrollment runs via CMS-855I or CMS-855B (CMS-855R covers reassignment of benefits). Commercial payer applications and behavioral health carve-out enrollment with Optum, Carelon, Evernorth, and Magellan move in parallel.
State Medicaid filing, NPDB verification, primary source verification through each payer’s credentialing committee, and recredentialing every two to three years round out the scope. NCQA 2025 standards cap accredited verification at 120 days. The outcome is an effective date, the calendar day in-network billing turns on.
NPI Type 1 and Type 2 registration runs through NPPES with the taxonomy code. State license verification, education credentials, and supervised hours documentation enter the file in a single intake. A 5-year work history audit closes the pre-submission gap audit.
CAQH ProView functions as the data spine for 90% of commercial behavioral health payers. Profile creation or existing-profile audit anchors the process. The 120-day re-attestation cycle continues afterward.
Parallel submission compresses 4 to 8 weeks out of the timeline. Commercial scope spans Aetna Behavioral Health, Cigna/Evernorth, UnitedHealthcare/Optum, BCBS state plans, Humana Behavioral Health, and TRICARE regional contractors.
Medicare PECOS enrollment runs through CMS-855I for individuals and CMS-855B for groups. State Medicaid enrollment covers every jurisdiction. Medicaid MCO applications are submitted alongside the base state file.
Direct enrollment proceeds with Optum Behavioral Health, Carelon Behavioral Health, and Lucet. Each MBHO has its own credentialing committee. Per-MBHO timelines range from 60 to 120 days.
ABA panel enrollment requires verification of BACB certification. Multi-state telehealth credentialing pulls state-specific license verification across every jurisdiction the clinician serves.
1:- Commercial plans rarely credential mental health clinicians in-house. UnitedHealthcare hands behavioral health to Optum.
Anthem hands it to Carelon (a brand layered over the former Beacon Health Options, originally ValueOptions). Cigna routes through Evernorth. An LCSW application mailed to the parent payer comes back rejected within days.
1:- Physician-tier credentialing forms ask for residencies, fellowships, and hospital privileges that master’s-level clinicians do not hold.
2:- Generic credentialers staple LCSWs, LMFTs, and LPCs into those forms anyway. Primary source verification stalls and effective dates slip past the 120-day mark.
1:- PMHNPs prescribe under medical panels (E/M codes 99213 through 99215) while billing psychotherapy through behavioral health panels (90832, 90834, 90837).
Generic medical credentialers apply standard medical template-like approaches to behavioral health files. The mistake produces the rejection patterns we see week after week.
Behavioural health carve-out routing
Master’s-level templates
PMHNP dual-panel
CAQH re-attestation
Recredentialing
Recredentialing
Submission strategy
Average timeline
Every commercial payer routes behavioral health credentialing through a separate front door from medical credentialing.
Aetna processes behavioral health credentialing through Aetna Behavioral Health using CAQH ProView as the upstream data source. Clean applications close in 60 to 90 days. Recredentialing runs every 3 years.
Cigna routes behavioral health credentialing through Evernorth Behavioral Health across most commercial plans. Standard processing falls between 60 and 90 days.
UnitedHealthcare behavioral health credentialing flows through Optum Behavioral Health via Provider Express. Standard processing falls between 60 and 90 days.
Anthem behavioral health clinical management routes through Carelon. Anthem keeps the contract and claims path. Carelon keeps the clinical credentialing path. Standard processing runs 90 to 120 days.
Blue Cross Blue Shield exists as 33 independent state plans rather than one entity. Standard processing falls between 60 and 120 days by state. Some BCBS plans delegate behavioral health to separate MBHOs.
Medicare enrollment runs through PECOS at pecos.cms.hhs.gov. CMS-855I covers individuals. CMS-855B covers groups. CMS-855R covers reassignment of benefits. Standard PECOS processing falls between 45 and 65 days.
TRICARE behavioral health credentialing splits regionally. TRICARE East through Humana Military, TRICARE West through TriWest. Standard processing falls between 90 and 120 days.
State Medicaid enrollment timelines range from 30 days in fast states to 120+ days in slow ones. Each state Medicaid program runs its own enrollment.
Transitioning to a new billing company often disrupts cash flow. We follow a strict 30-day onboarding schedule to prevent payment gaps.
Week 1:
Profile creation or existing-profile audit anchors this phase. Primary source documents upload against payer requirements. First attestation submits at the phase end. CAQH completion gates 90% of commercial behavioral health applications downstream.
Weeks 1 to 2
Profile creation or existing-profile audit anchors this phase. Primary source documents upload against payer requirements. First attestation submits at the phase end. CAQH completion gates 90% of commercial behavioral health applications downstream.
Week 2
Intake covers state license, malpractice certificate, NPI Type 1 and Type 2, DEA certificate, where applicable, board certifications, education verification, and supervised hours. Also, a 5-year work history, malpractice claims history, and hospital privileges, where applicable. Plus 3 professional references.
Weeks 3 to 12
Payer credentialing committees receive a cadenced follow-up every 10 to 14 days. Primary source verification requests, additional document requests, and committee questions draw responses within 24 hours.
Weeks 12 to 16
Fee schedules undergo line-by-line review before signature. Effective dates are confirmed in writing. Single case agreements or gap exceptions bridge high-need cases during transition.
Ongoing
CAQH re-attestation every 120 days. Recredentialing every 2 to 3 years per payer. Medicare PECOS revalidation every 5 years.
MHBS serves behavioral health providers in all 50 US states. Every state runs its own license verification rules, Medicaid enrollment process, and managed care routing. Multi-state telehealth providers require credentialing across every jurisdiction where licensure remains active.
We clear Texas STAR Medicaid requirements and manage strict prior authorizations for regional MCOs like Superior HealthPlan and Amerigroup.
We enforce NYS OMH compliance rules and route claims accurately through complex Empire BCBS behavioral health carve-outs.
We process mandatory Medi-Cal Treatment Authorization Requests (TARs) and route claims correctly through local Kaiser networks.
We match Florida AHCA fee schedules and secure active authorizations through managed care plans like Sunshine Health and Simply Healthcare.
We bill directly to HUSKY Health Medicaid and manage strict behavioral health session limits for ConnectiCare and Anthem BCBS.
We route claims accurately through NJ FamilyCare and track the strict therapy session limits for Horizon BCBS plans.
We ensure exact compliance with the state behavioral health manual and bill directly to Next Generation MCOs like CareSource and Buckeye Health.
We clear claims through Healthy Connections Medicaid and track precise panel requirements for BlueChoice HealthPlan and Absolute Total Care.
Metro coverage extends to New York City, Los Angeles, Chicago, Houston, Dallas-Fort Worth, Phoenix, Philadelphia, San Antonio, San Diego, Miami, Atlanta, Boston, Seattle, Denver, Washington DC, San Francisco Bay Area, Minneapolis-Saint Paul, Portland, Charlotte, Nashville, Austin, Las Vegas, Detroit, Tampa, Indianapolis, Columbus, and Sacramento.
“Working with this billing team has completely changed the way we manage our practice revenue. Their attention to detail, fast claim submissions, and follow-up on denied claims helped us improve reimbursements within the first few months. I finally have peace of mind knowing our billing is handled professionally.”
Mental health credentialing takes 60 to 120 days, depending on payer and provider type. Medicare PECOS averages 45 to 65 days. Aetna, Cigna/Evernorth, and UnitedHealthcare/Optum average 60 to 90 days. Anthem/Carelon and most BCBS plans average 90 to 120 days.
Credentialing verifies provider qualifications against payer standards. Contracting establishes the payment relationship plus the fee schedule. A cleared credentialing file cannot bill until the contract is executed.
CAQH ProView is required by 90% of commercial behavioral health payers. Re-attestation runs every 120 days. Lapsed profiles trigger silent panel suspension across multiple payers at once.
Every 120 days. Missed attestation flips the profile to inactive status across the payer landscape.
A behavioral health carve-out is the arrangement under which a commercial plan delegates mental health benefits to an MBHO. UnitedHealthcare delegates to Optum. Anthem delegates to Carelon. Cigna delegates to Evernorth.
Carve-outs let commercial payers outsource specialized network management plus clinical review. The MBHO holds the credentialing committee. Files sent to the parent payer trigger automatic rejection.
Yes. The 2024 Medicare expansion brought LMFTs and LMHCs into billing eligibility at 75% of the Medicare Physician Fee Schedule. Enrollment runs through PECOS using CMS-855I.
Multi-state telehealth providers require credentialing across every state where licensure remains active. Each state Medicaid program runs independent enrollment.
MHBS charges a flat per-payer application fee with no monthly retainer. Bundled pricing covers 5+ payer applications submitted together.
Lapsed profiles trigger silent panel suspension. Claims during suspension face denial. Reinstatement commonly takes 30 to 60 days.
Commercial payers recredential every 2 to 3 years. NCQA-accredited payers run standardized 3-year cycles. Medicare PECOS revalidation runs every 5 years.
Out-of-network billing remains available. In-network billing requires the effective date. Single case agreements bridge high-need cases inside the waiting window.
Commercial credentialing runs through CAQH plus individual payer portals. Federal revalidation runs every 5 years, versus commercial recredentialing every 2 to 3 years.
Yes. PMHNPs bill medication management E/M codes through medical panels plus psychotherapy through behavioral health carve-outs. Single-panel enrollment strands 30%+ of billable revenue.
The 2024 Medicare expansion added LMFTs and LMHCs as billable providers at 75% of the Medicare Physician Fee Schedule. Enrollment runs through PECOS using CMS-855I.
MHBS serves behavioral health providers in all 50 US states. Every state runs its own license verification rules, Medicaid enrollment process, and managed care routing. Multi-state telehealth providers require credentialing across every jurisdiction where licensure remains active.
Simplifying mental health billing with accurate claims, faster reimbursements, and seamless revenue cycle management.
info@mentalhealthbillingservice.com
(860) 500-1471
403, Port Washington Road
