Credentialing software for behavioral health
If the clinicians you credential are therapists, counselors and psychiatrists, your work is harder than the general case in specific ways. This page is about those ways, and about the tool we are building for the people who do it.
PayerHarbor is software for the people who do credentialing, not a service that does the credentialing for you. Whoever does it — for your own practice, or for practices you look after — it is built for you.
Four things that make this specialty harder
The medical network is often not the behavioral health network
Many health plans hand mental health benefits to a separate specialty company with its own network and its own credentialing; others keep the work in house. Both are common, which is exactly why neither can be assumed, and where the first applies a clinician approved by the medical plan may still not be in network for therapy. The detail, with the payers' own documents linked, is in being in a health plan's medical network may not put you in its behavioral health network.
Panels close on this specialty more than most
A payer that is not accepting new behavioral health clinicians in an area is not rejecting anybody. It means apply again later. That is a different thing from a denial and it needs a different record: a date worth trying again, not a failure to explain to your client. Most trackers have nowhere to put it, so it lives in somebody's memory.
Providers join, leave and change affiliations
Each of those changes is its own piece of payer work. An arrival is a full set of applications across every payer the practice works with. A departure leaves enrollments that have to be ended rather than forgotten. A clinician who works at two practices is one person who must not become two records. None of it is hard on its own; what makes it hard is that each change fans out across every payer separately, and a step missed at one of them is not noticed until a claim is denied.
Prescribers and non-prescribers need different paperwork
A counselor, a psychologist and a psychiatric nurse practitioner are not interchangeable on a payer application. One has a DEA registration and two do not; board certification applies to some disciplines and not others; hospital privileges are asked for by several payers and held by very few behavioral health clinicians, which usually means a written admitting arrangement instead. A checklist that assumes every provider needs the same nine documents produces chasing that was never necessary and gaps that were.
Where the payer homework starts
Behavioral health credentialing is mostly payer-specific knowledge: which payer takes which form, in which portal, and what it does when an answer is late. A product that only holds dates and statuses leaves all of that with the person doing the work. So we are doing the homework payer by payer, and the first set we have written down is California, because that is where the people currently working with us do the job. Four examples of the kind of detail this means:
Medi-Cal enrollment through PAVE
A clinician who will bill Medi-Cal is enrolled with the state itself, through its PAVE portal, before anything else can happen. That is five state forms and an affiliation application that both the group and the clinician sign, one set per clinician, with no roster shortcut. A decision can take up to 180 days, and if the state asks for more information through the portal and the answer misses its window, the application can go back to the start. It can be one of the more paperwork-heavy enrollment workflows a California behavioral health group deals with, and we have not found it mentioned in the credentialing products we reviewed.
The county plan, and the statewide route it now runs on
County mental health plans in California are moving their credentialing onto a single statewide application, run for the counties by CalMHSA with a verification organization doing the checking. Eleven counties are on it. The clinician receives a link and a sequence of emails, and after three ignored emails the application is closed and the county told. It does not cover Medi-Cal or Medicare enrollment, so it sits beside the state paperwork rather than replacing it. What is left for the person at the practice is knowing the invitation arrived, chasing their own clinician before somebody else’s system closes the file, and knowing when the three-year re-credentialing falls due. Some county health plans still take their own packet as well — one of them asks for thirteen items.
Kaiser, which works differently from the rest
Kaiser Permanente in Northern California runs its own credentialing process: its own application, its own portal, a fax line for the initial submission, and a published completeness checklist. It does not appear to pull from the national provider data portal the way the commercial plans increasingly do. Ten to twelve weeks is their own estimate, and a complete application going in the first time is what keeps it to that.
Associates under supervision
Behavioral health runs on registered associates — in California, AMFTs, ASWs and APCCs — who see patients under a licensed supervisor while they accumulate hours. Every payer treats them differently: at least one county plan requires a signed supervisory letter for each; others enroll only the supervisor; some will not enroll them at all. The paperwork changes again when an associate becomes licensed, and when a supervisor leaves. We have not found these categories handled explicitly in the products we reviewed, and they can account for a lot of the work at a practice that trains clinicians. Most states have their own pre-licensure categories and the same question to answer for each payer.
If you are not in California
Everything above the payer names applies wherever you are. How a practice, its clinicians, its credentials and its enrollments are recorded is general, and so are closed panels, expiration clocks, roster changes and the difference between an approval date and an effective date. What is specific is the process knowledge for each payer, and that gets added a payer at a time. If you do this work in another state and the payers you deal with are not covered yet, tell us which ones they are — that is how they get added, and it is worth getting in touch before you need it rather than after.
What the software does about it
PayerHarbor is a multi-client workspace for behavioral health credentialing: your client practices, their providers, and every credential and mental health payer enrollment underneath them, in one place rather than one spreadsheet per practice.
It is being built to do more than record where an enrollment stands. Where a payer accepts forms or documents, the aim is to prepare as much of the submission as the payer allows. Where the payer owns the workflow, the aim is to guide the work and keep the actions it requires from being missed. What is listed below is the part that exists first, because knowing the true state of every enrollment is what everything else is built on.
- One row per provider, per payer — so a clinician can be in network with one payer, waiting on a second and blocked by a closed panel at a third, without any of it being squeezed into a single status.
- A closed panel recorded as a closed panel, with the date it is worth trying again.
- Approval date and effective date kept apart, because the gap between them is money.
- Ownership and workload — who is chasing what, and what has stopped moving.
- Expiration tracking for licenses, DEA, board certification and CAQH re-attestation. That last one generally runs on a 120-day cycle, with Illinois on 180, and has to be confirmed whether anything changed or not; the cycles and what happens when one lapses are set out, with the source, in the credentialing terms that actually affect the work.
- A status report you can send to a practice you do this for, with your name on it.
- CSV import from the spreadsheet you use today, and full export whenever you want.
A clinician who works at two practices stays one provider record connected to both, rather than being duplicated across separate practice spreadsheets.
Where this stands, and what you can have today
The software is still being built and cannot be signed up for yet. When it is ready there will be a thirty day trial, with no card to start it. Pricing is published rather than quoted, at $39 a month plus $3 per active provider, with no demonstration required — the prices are here and they will not become a negotiation.
The tracker is finished. It is a spreadsheet that follows applications through to the date you can bill, with a column for which practice each row belongs to, a checklist for taking on a new client practice, and worked examples that use behavioral health practices throughout. It is free, it is not gated, and it is useful whether or not you ever buy anything from us: take the tracker.
If you would rather be told when the trial opens, leave an address on the main page and we will send one message when it does.