Services — Insurance Credentialing
Insurance Credentialing for Psychotherapists and Psychiatrists
Mental health credentialing services from MCM South: getting approved by insurance companies is the step that lets you bill them. We handle the paperwork and payer follow-up, for new practices and growing ones.
WHO THIS IS FOR
- Newly licensed providers
- Psychiatrists (MDs)
- Solo practices
- Group practices
What it is
What is insurance credentialing?
Insurance credentialing is the process an insurance company uses to verify a provider’s license, education, training, and work history before admitting them to its network. It is done payer by payer. Most payers collect this information through an application, often submitted through CAQH (now called DataSpring; formerly the Council for Affordable Quality Healthcare), a shared provider-data system, and then check it against the original sources. Approval and contracting are separate steps: a provider can be credentialed and still wait on a contract and an effective date.
Your National Provider Identifier (NPI) comes first. You get it through NPPES, the CMS system that issues NPIs. See the plain-English definitions in our credentialing terms glossary.
Medicare works differently. Medicare enrollment goes through the CMS PECOS (Provider Enrollment, Chain and Ownership System), not a commercial payer application. Medicaid enrollment is run by each state. Rules vary by state and payer; confirm with each.
Reimbursement
How credentialing affects reimbursement
A provider who is in-network has a contract with the payer, so claims are paid at that contract’s rates and the practice agrees to its billing rules. A provider who is out-of-network has no contract, and payment depends on the patient’s plan. From the practice’s point of view, that means different rates, different collection steps, and often a different amount to collect from the patient. Plans differ, so the benefits check comes first. We cover the trade-offs in In-Network vs. Out-of-Network Credentialing. Our Insurance Verification & Eligibility Checks service handles the benefits check.
How MCM South helps
Our mental health credentialing services
We prepare and submit the applications, track each one, and follow up with the payer until there is an answer. We serve both psychotherapists and psychiatrists. Psychiatrists’ applications carry extra items, such as prescribing credentials, and we build for that.
Newly licensed providers
A first credentialing round for a first practice.
Psychiatrists (MDs)
Applications that reflect prescribing and medication-management billing. See the CPT & E/M Code Guide. Prescriber codes are in the E/M and home-visit codes section.
Credentials we support
The mental health credentials we credential
Most commercial insurers, Medicare, and Medicaid programs commonly credential the license types below. We prepare and submit applications for psychotherapists and psychiatrists at each of these levels. Credential titles vary by state, so we confirm yours before we start.
Prescribers
- Psychiatrists (MD, DO): medical doctors and doctors of osteopathic medicine
- Psychiatric nurse practitioners (PMHNP-BC, APRN): psychiatric-mental health nurse practitioner, board certified; advanced practice registered nurse
Psychologists and social workers
- Psychologists (Ph.D., Psy.D.)
- Clinical social workers (LCSW, LICSW): licensed clinical social worker; licensed independent clinical social worker
Counselors, therapists, and SUD providers
- Professional counselors (LPC, LPCC, LCPC, LMHC): licensed professional counselor, professional clinical counselor, clinical professional counselor, mental health counselor
- Marriage and family therapists (LMFT)
- Substance use disorder (SUD) providers (LADC, CADC, CSAC): licensed or certified alcohol and drug counselors; certified substance abuse counselor
Each payer sets its own rules for each license type. Medicare and Medicaid enrollment differs by license and by state, and substance use disorder counselor credentials are accepted by some payers and programs but not others. Some payers also do not credential associate-level (pre-licensed) clinicians, and prescribing and supervision rules for APRNs vary by state. We confirm each payer’s current rules before we submit.
Payer note (source: Anthem Blue Cross and Blue Shield, as of October 2026): Anthem Blue Cross and Blue Shield operates in Colorado, Connecticut, Georgia, and 17 southeastern counties of New York. Other Blue Cross Blue Shield plans in our other served states are separate companies with their own rules.
What to expect
What to expect from our credentialing services
Every payer works a little differently. This is the general path our mental health credentialing services follow.
1
We gather your license, NPI, education, malpractice, and work-history documents.
2
The application goes to the payer, usually through CAQH or the payer’s own portal.
3
The payer verifies it against original sources and sends it to its credentialing committee.
4
You receive an approval and a contract, with an effective date. We confirm that date before you schedule that payer’s patients.
5
We add the payer to your billing setup, so claims go out correctly (see our Electronic Claims Submission service).
How long each payer takes varies. We do not quote a number of days; ask us about the payers you have in mind. See plain-English definitions in our billing terms glossary, or browse all Resources.
FAQ
Mental health credentialing services: common questions
Credentialing is the payer verifying your qualifications. Contracting is the agreement on rates and rules that follows. You are in-network for billing purposes only once both are complete and an effective date is issued.
To be paid as an in-network provider, yes. Without it you are out-of-network, and payment depends on the patient’s plan. Confirm each payer’s rules.
It varies by payer and by how complete the application is. Payers set their own review schedules, so ask each payer, and plan for the effective date, not the application date.
No. Medicare enrollment goes through CMS’s PECOS system. Commercial payers and each state’s Medicaid program use their own applications.
We credential psychiatrists (MD, DO), psychiatric nurse practitioners (PMHNP-BC, APRN), psychologists (Ph.D., Psy.D.), clinical social workers (LCSW, LICSW), professional counselors (LPC, LPCC, LCPC, LMHC), marriage and family therapists (LMFT), and substance use disorder providers (LADC, CADC, CSAC). Titles and payer rules vary by state, so we confirm yours first. We serve both psychotherapists and psychiatrists, including the prescribing details psychiatrists’ applications require.
Ready to get in-network?
Get a free, no-pressure consultation about our credentialing services with a specialist who only works mental and behavioral health billing.