Credentialing and Insurance Resources

Credentialing takes a while, that's why when I was in a hurry, I used Alma to get started on getting paid, and then went through the process of credentialing on my own until I had completed credentialing and contracting with enough payers to sustain my practice.  The first link will give you an idea of what reimbursement rates look like for masters level mental health clinicians. My current insurance payer rates for a one-hour session are between $50 and $150 as a licensed psychologist. The average is around $130.

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When you are considering what insurance to credential with, or if you want to take insurance at all, please keep a few things in mind. First, it's not that difficult once it's set up. The right EHR + Billing and a little patience is all it really takes to be successful as an insurance based practice. Next, when looking at the vast differences between the lowest and highest payers, it may be tempting to just credential with the highest payers and snub the rest. Consider who you intend to provide services for in your community. What insurance payers are used in that industry area? And finally, the rumors about Medicaid and Medicare being unsustainable are not really true for Mental Health. Their rates are published. Look at them and make your own decision about whether or not to participate. Again, with the right software and billing service, you're not going to notice a huge difference between public and private insurance.

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Therathink 2024 Insurance Reimbursement Rate Tables - These are general rates and give a great overview. 

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Alma - This is a paid service that charges a monthly fee, provides billing services, client referrals, and credentialing support.  I started my practice using Alma and I highly recommend it for the first time solo private practice. Note the link here will take you to their website from my private referral link, and if you join within 90 days and stay for 60, I will get a $500 referral bonus.  The bonus is not why I recommend them. This has been an extremely positive experience for me and helped me fill my practice while I was getting credentialed on my own. Even when Change Healthcare was down, Alma kept paying me. I regularly recommend Alma to my clients trying to find therapists for family members or when they move. The matching algorithm has been fantastic. And I can confirm their claim that their rates are better than what we get on our own.  I'd stay with them if they would institute a group practice program that was more cohesive.

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Aetna - Large insurance panel, takes a very long time to complete the process.  This panel pays well compared to others in North Texas. They seem to have streamlined the process for getting credentialed from what it was two years ago.

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Anthem Blue Cross Blue Shield - Another large insurance panel, but theme to get credentialed was much shorter. Th pay rates are reasonable, and the support for providers has been very good in my experience.

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Evernorth Behavioral Health - This was known as Cigna until recently. The rates are lower than some others, but they provide insurance to a number of First Responders, and large companies in my area. Knowing who you want to serve is sometimes more important than the bottom line (as long as you are paying all the bills).

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Magellan Healthcare - This payer is one of the lowest rates I have seen. This provider also services First Responders in our area. Many times, the lowest cost MarketPlace Insurance plans for Blue Cross Blue Shield will subcontract out their mental health services to Magellan.

Medicare - This page introduces you to what you need to do to enroll as a Medicare provider.  It may look complicated, but there are tutorials on YouTube at the bottom of the screen.  The rate for Medicare is higher than most private payers, but it is more complicated to bill on your own, depending on what software you use.  I have never had an issue with TherapyNotes.

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Texas Medicaid - This page is for information about Texas Medicaid for Providers. The truth about Medicaid reimbursement for mental health services is that it is on par with other health plans. In 2024, the psychologist rate for 90837 (60 Minutes of Therapy) is $116.81 for adults aged 21 and up and $122.65 for youth aged 20 and younger. This is more than twice the rate of the lowest paying panel I am credentialed with (they are an EAP provider for first responders), and about $35 less than the highest paying panel I am credentialed with.  Masters levels clinicians can expect 70% of the above rates for TX Medicaid, which is on par with the general practice of private payers.