Reimbursement for Behavioral Health

As we begin providing the service to currently, what a huge difference. At the beginning of the pandemic, they allowed sole practitioners such as Licensed Clinical Social Workers to become a participating provider in a group practice. Now, Licensed Clinical Social Workers must have 5 or more health professionals under their group to be a group practice.  These carriers are Cigna & UHC. Aetna is allowing Licensed Masters Social Workers as sole Practitioners or group practice as long as the entity has a supervisor as a Licensed Clinical Social Worker, Nurse Practitioner in Psychiatry, or Physician Assistant. 

With all these changes, the carriers that remain the same are Medicare and Medicaid. Many states require you to be credentialed with Medicare, to get Credentialed with Medicaid. I highly recommend starting with these two carriers first, as long as you or an individual in your practice has the credentials the carrier recognizes. Visit your state Medicare and Medicaid website for the list of credentials. In the state of Florida they have a rule, Licensed Clinical Social Worker must have a Physician ( Psychiatrist) or Nurse Practitioner in Psychiatry in their practice to become a participating provider. We always inform providers to check with your state rules, and as a business person, it's best to be aware and involved "IT'S YOUR BUSINESS".

If you are seeking to become a participating provider with health insurance carriers, click here POST & CLAIM IT DOCUMENTS CRASH COURSE to ensure you have all the proper documents for the credentialing process.