Insurance credentialing for therapists is the process of getting a health plan to review your professional information and add you to its provider network, so you can bill that plan for sessions with its members. On Aetna's published path, you request participation, contract, are credentialed from your CAQH application, and then receive a finalized contract (Aetna, join the network). CAQH's Provider Data Portal stores the license, training certificates, and liability insurance that plans review (CAQH, Provider Data Portal FAQs).
This guide is for licensed professional counselors (LPCs), licensed clinical social workers (LCSWs), licensed marriage and family therapists (LMFTs), and psychologists who are weighing or starting the process. It covers how to decide whether to join a panel, what to gather first, the six steps in order, what one payer publishes about its timeline, how Medicare enrollment works for each license type, and when a credentialing company makes sense. If you also offer nutrition care, our guide to insurance credentialing for dietitians covers that path with its medical nutrition therapy codes.
Credentialing is the payer's review of your application. Paneling is acceptance into the payer's network of providers. Contracting is the agreement that governs how you work with the plan. A payer's own page shows why the distinction matters: the order of the steps differs from payer to payer.
Aetna's page lists the sequence as a request for participation, a check on whether contracting or credentialing is required, credentialing from your CAQH application, and a finalized contract after credentialing is complete (Aetna, join the network). Its provider bulletin places the first contracting stage before credentialing, with a countersigned contract after approval (Aetna provider education bulletin, spring 2025). Read each payer's own sequence before you start, because a checklist built for another payer's order will mislead you.
Join a panel when the clients you want to serve carry plans you can bill and those plans are accepting providers with your license in your area. The three payment paths work differently:
| Path | How you get paid | What you need |
|---|---|---|
| In-network | You bill the plan after it confirms your participation effective date | NPI, CAQH profile, an open panel, a signed contract |
| Out of network with superbills | The client pays you, and you give them a superbill to submit to their own insurer | A superbill with the codes and diagnoses the insurer asks for |
| Private pay | The client pays you directly | Your own fee and payment policies |
Practice Better's guide to superbills defines a superbill as a standardized, detailed invoice you give clients as a receipt after they pay, and says clients can submit it to their insurer for full or partial reimbursement if their policy allows (Your super guide to superbills). The same guide notes that superbills are commonly used by practices that do not accept insurance or are out of network for a client's plan.
Test the in-network path against your own practice before you apply:
If the answers to the first two questions come back unclear, start with superbills and private pay while you collect the answers.
Collect these items before you open any payer application:
If you will practice by telehealth in more than one state, plan for each state separately. Practice Better's NPI guide says that even with one NPI, you credential with insurance panels separately in each state (Why, when, and how to get an NPI number).
Work through six steps in this order: get your NPI, build your CAQH profile, choose payers and request participation, follow the credentialing and contracting stages, review the contract and confirm your effective date, and keep your records current. Each step below covers one stage.
The National Provider Identifier is a 10-digit identifier assigned through the National Plan and Provider Enumeration System (NPPES), which CMS maintains (CMS, NPI fact sheet). You can apply online at NPPES, send a paper form, or authorize an employer or trusted organization to obtain one for you (CMS, how to apply). CMS recommends the web-based application for the fastest receipt of an NPI (CMS, how to apply), and CMS's prescriber guidance says the NPI is free of charge (CMS, NPI requirements for prescribers).
Individuals receive a Type 1 NPI, and an individual who is incorporated can also obtain a Type 2 NPI for the corporation or LLC (CMS, NPI fact sheet). Two application details come from Practice Better's NPI guide: your name on the application has to match your state license, and the taxonomy code you select identifies your specialty, so a wrong one can delay processing (Why, when, and how to get an NPI number). CMS publishes taxonomy codes for two of the license types on Medicare's list: 106H00000X for marriage and family therapists and 101YM0800X for mental health counselors (CMS, MFT and MHC enrollment FAQs).
An NPI leaves enrollment in each health plan as its own step. CMS states that holding one does not enroll you in a plan or guarantee payment by a plan (CMS, NPI fact sheet). Once you have one, CMS requires covered providers to report any change to NPI information within 30 days of the change (CMS, NPI fact sheet).
Register at CAQH, complete every section, upload your documents, and attest that the information is accurate. CAQH says the initial profile can take up to two hours (CAQH, getting started). The portal is free for providers, and health plans pay to use the data (CAQH, Provider Data Portal FAQs). CAQH's own site now calls the tool the Provider Data Portal, and Aetna's pages still refer to it as CAQH ProView, which is the name you will see in their instructions.
You decide who sees your profile. CAQH's quick reference says only you can authorize who has access to your information (CAQH, ProView quick reference), and Aetna's join page tells you to designate Aetna as an authorized health plan so it can access your application (Aetna, join the network). Add each payer you apply to.
Re-attest on schedule. CAQH requires attestation every 120 days, or every 180 days for Illinois providers, and a profile that misses the window moves to Expired status (CAQH, Provider Data Portal FAQs). Aetna's bulletin asks that your profile show a "Re-attestation" or "Initial Application Complete" status (Aetna provider education bulletin). Set a calendar reminder for the day you finish.
Start with the plans your current clients and waitlist carry, and apply to each payer through its own provider network page. On Aetna's form, the payer reviews the request and makes a decision within 60 days. If the panel is open and Aetna intends to pursue a contract, a network manager contacts you to start formal credentialing, and if the panel is not open you receive a denial by letter or email (Aetna, join the network). Aetna requires a separate application for each provider in a group (Aetna, join the network).
Aetna says it evaluates the current need to service its membership in your area before it decides whether contracting or credentialing applies (Aetna, join the network). After a closed-panel response, ask the payer whether and when the panel in your area reopens, and keep your other payer requests moving.
Choose a first round short enough to track by hand, so you can answer each payer's follow-up requests the day they arrive.
After a payer opens the door, it pulls your CAQH application and verifies it. Your job in this stage is to keep the profile attested and respond when the payer asks for something. Aetna's bulletin gives a contact route for any request that exceeds the published timelines (Aetna provider education bulletin), so write down the date you submitted and the date each stage should end. The next section lays out Aetna's stages.
Aetna sends its contract as an electronic document you sign through Adobe Sign, and after credentialing is approved it countersigns and returns the final contract (Aetna provider education bulletin). Before you sign any payer's contract, ask for the fee schedule that applies to you and compare the rate for each CPT code you plan to bill against what it costs you to deliver the session. Our guide to therapy billing codes covers the codes mental health practices use.
Ask for your participation effective date in writing. Aetna's bulletin says its systems reflect your participation effective date once the final contract is returned, and that you can submit claims from that point (Aetna provider education bulletin).
Credentialing continues after the effective date. CAQH requires re-attestation every 120 days, as covered in Step 2. For NPI changes, CMS requires covered providers to report any change within 30 days of the change (CMS, NPI fact sheet). Aetna says it uses CAQH for recredentialing as well, so your attestation schedule stays relevant after you join (Aetna, joining the provider network FAQs). Ask each payer for its recredentialing cycle and add the date to your calendar.
Aetna publishes the stage windows for its process, and they run through the 120-day mark. Other payers publish their own, so treat the table as one payer's worked example for planning.
| Stage on Aetna's schedule | Published window | What happens |
|---|---|---|
| Request for participation | 1 to 30 days | You complete the request, and Aetna emails you whether it intends to pursue a contract |
| Contracting | 30 to 60 days | The local network team begins contracting, and you sign electronically |
| Credentialing | 60 to 90 days | Aetna requests credentialing once it receives your signed contract and obtains your application from CAQH |
| Final contracting | 90 to 120 days | After approval, Aetna countersigns, shows your participation effective date, and you can submit claims |
Source: Aetna provider education bulletin, spring 2025. Aetna's join page gives its own decision window for the first stage, 60 days from your request (Aetna, join the network), so confirm your dates with the payer's staff once you apply.
If a plan publishes a schedule like this one, plan for the full span between your first request and your first billable session. The part you control is your own side of the file: a complete CAQH profile with the right status and authorization, matching names across your license, NPI and application, and prompt replies to requests.
Medicare handles provider participation through enrollment with CMS. The path for a therapist runs through an Identity & Access Management account, an NPI, and an application in PECOS (the online enrollment system) or a paper CMS-855I, submitted to your Medicare Administrative Contractor (CMS, MFT and MHC page). A separate CMS-855I enrollment is required in each state where you render services (CMS, MFT and MHC enrollment FAQs).
CMS's mental health booklet lists clinical psychologists and clinical social workers among the practitioners Medicare Part B covers (CMS, Medicare and mental health coverage). Effective January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare independently, paid at 75% of what a clinical psychologist receives under the Medicare Physician Fee Schedule (CMS, MFT and MHC page).
| License type | Qualifications CMS lists |
|---|---|
| Clinical psychologist | A psychology doctoral degree, and a license or certification at the independent level in the state where you practice |
| Clinical social worker | A social work master's or doctoral degree, at least 2 years of supervised clinical social work, and a state license or certification |
| Marriage and family therapist | A qualifying master's or doctor's degree, at least 2 years or 3,000 hours of post-master's supervised clinical experience, and a state license or certification |
| Mental health counselor | The same degree and experience requirements as an MFT, with a license or certification as a mental health counselor, clinical professional counselor, or professional counselor |
Sources: CMS, Medicare and mental health coverage for clinical psychologists and clinical social workers; CMS, MFT and MHC page for MFTs and MHCs.
Two details from CMS's MFT and MHC enrollment FAQs save time. MFTs and MHCs are limited-risk providers and pay no application fee. PECOS lists the MFT and MHC specialties, while the paper CMS-855I asks you to select the Undefined Non-Physician Practitioner option in section 2H and write in MFT or MHC (CMS, MFT and MHC enrollment FAQs).
A credentialing company completes the NPI, CAQH, and payer application work on your behalf, for a fee. Doing it yourself costs your time, since CAQH is free to providers (CAQH, Provider Data Portal FAQs) and so is the NPI (CMS, NPI requirements for prescribers). Any fee a service charges pays for its labor and expertise. The decision comes down to your answers to these questions:
If you hire a service, run these checks first:
Yes, as private-pay or out-of-network clients. Until a payer confirms your participation effective date, treat sessions as private-pay or out-of-network, as covered in Step 5. You can give clients a superbill after they pay you, and they submit it to their insurer for reimbursement if their policy allows (Your super guide to superbills). Tell new clients the status of each payer application in your intake materials, so nobody assumes you are in-network before you are.
These causes come from payer and CMS pages and from Practice Better's NPI guide:
The steps above happen on the CAQH site and on each payer's site. Once a payer confirms your effective date, the day-to-day work moves into billing: eligibility checks, claims, and rejections. Practice Better's billing and insurance page says US customers can check eligibility, submit claims, track status, manage rejections, and invoice clients for unpaid portions through the Claim.MD integration. It also says you can connect to Office Ally and more than 5,000 payers with format-ready CMS-1500 exports.
Without a Claim.MD account, you can still set up an insurance billing profile, export CMS-1500 claims, and send superbills, though claims are submitted outside Practice Better and you cannot track ERAs there (billing and insurance). Claim.MD requires its own account, and each practitioner on your team completes their own provider enrollment with Claim.MD before submitting claims (Claim.MD + Practice Better). Storing your NPI in your insurance billing profile includes it automatically on your CMS-1500 forms (Why, when, and how to get an NPI number). To add it, go to Settings (gear icon) > All Settings > Insurance Billing and enter your individual NPI in the My Profile section (setting up your insurance billing profile). For choosing a system for a therapy practice, see mental health practice management software and the Practice Better page for mental health professionals.
Start your free trial to set up your billing profile and superbills while your panel applications run.
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Each payer publishes its own stages. Aetna's provider bulletin labels the stages as 1 to 30 days, 30 to 60 days, 60 to 90 days, and 90 to 120 days, ending with a countersigned contract and a participation effective date (Aetna provider education bulletin, spring 2025). Ask each payer you apply to for its current windows.
Yes. Health plans, including Medicare, Medicaid, and private plans, require NPIs in their administrative and financial transactions, and an individual provider applies for a Type 1 NPI through NPPES (CMS, NPI fact sheet). CMS's prescriber guidance says the NPI is free of charge (CMS, NPI requirements for prescribers).
CAQH's Provider Data Portal is a platform where providers enter and verify professional information and share it with the organizations they authorize, and it is free for providers (CAQH, Provider Data Portal FAQs). Aetna says it uses CAQH ProView for credentialing and recredentialing (Aetna, joining the provider network FAQs). You re-attest every 120 days, or every 180 days in Illinois.
Medicare Part B covers clinical psychologists and clinical social workers, and since January 1, 2024 it also pays marriage and family therapists and mental health counselors, who qualify when they hold the required degree, supervised experience, and state license (CMS, MFT and MHC page). CMS's FAQs say a professional with a state title such as clinical professional counselor or professional counselor can enroll as a mental health counselor when the license meets the regulatory definition, and you enroll through PECOS or the CMS-855I (CMS, MFT and MHC enrollment FAQs).
Use one when the number of payers, the hours it takes, or your schedule makes the project cost more than the service's fee. CAQH and the NPI are free, so a fee pays for the service's labor. Keep your CAQH login in your own name, since only you can authorize who has access to your information (CAQH, ProView quick reference).
Yes, as private-pay or out-of-network clients. You give them a superbill after they pay you, and they submit it to their insurer for reimbursement if their policy allows (Your super guide to superbills). Aetna's bulletin says you can submit claims once your participation effective date is reflected in its systems (Aetna provider education bulletin).
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Insurance credentialing for therapists is the process of getting a health plan to review your professional information and add you to its provider network, so you can bill that plan for sessions with its members. On Aetna's published path, you request participation, contract, are credentialed from your CAQH application, and then receive a finalized contract (Aetna, join the network). CAQH's Provider Data Portal stores the license, training certificates, and liability insurance that plans review (CAQH, Provider Data Portal FAQs).
This guide is for licensed professional counselors (LPCs), licensed clinical social workers (LCSWs), licensed marriage and family therapists (LMFTs), and psychologists who are weighing or starting the process. It covers how to decide whether to join a panel, what to gather first, the six steps in order, what one payer publishes about its timeline, how Medicare enrollment works for each license type, and when a credentialing company makes sense. If you also offer nutrition care, our guide to insurance credentialing for dietitians covers that path with its medical nutrition therapy codes.
Credentialing is the payer's review of your application. Paneling is acceptance into the payer's network of providers. Contracting is the agreement that governs how you work with the plan. A payer's own page shows why the distinction matters: the order of the steps differs from payer to payer.
Aetna's page lists the sequence as a request for participation, a check on whether contracting or credentialing is required, credentialing from your CAQH application, and a finalized contract after credentialing is complete (Aetna, join the network). Its provider bulletin places the first contracting stage before credentialing, with a countersigned contract after approval (Aetna provider education bulletin, spring 2025). Read each payer's own sequence before you start, because a checklist built for another payer's order will mislead you.
Join a panel when the clients you want to serve carry plans you can bill and those plans are accepting providers with your license in your area. The three payment paths work differently:
| Path | How you get paid | What you need |
|---|---|---|
| In-network | You bill the plan after it confirms your participation effective date | NPI, CAQH profile, an open panel, a signed contract |
| Out of network with superbills | The client pays you, and you give them a superbill to submit to their own insurer | A superbill with the codes and diagnoses the insurer asks for |
| Private pay | The client pays you directly | Your own fee and payment policies |
Practice Better's guide to superbills defines a superbill as a standardized, detailed invoice you give clients as a receipt after they pay, and says clients can submit it to their insurer for full or partial reimbursement if their policy allows (Your super guide to superbills). The same guide notes that superbills are commonly used by practices that do not accept insurance or are out of network for a client's plan.
Test the in-network path against your own practice before you apply:
If the answers to the first two questions come back unclear, start with superbills and private pay while you collect the answers.
Collect these items before you open any payer application:
If you will practice by telehealth in more than one state, plan for each state separately. Practice Better's NPI guide says that even with one NPI, you credential with insurance panels separately in each state (Why, when, and how to get an NPI number).
Work through six steps in this order: get your NPI, build your CAQH profile, choose payers and request participation, follow the credentialing and contracting stages, review the contract and confirm your effective date, and keep your records current. Each step below covers one stage.
The National Provider Identifier is a 10-digit identifier assigned through the National Plan and Provider Enumeration System (NPPES), which CMS maintains (CMS, NPI fact sheet). You can apply online at NPPES, send a paper form, or authorize an employer or trusted organization to obtain one for you (CMS, how to apply). CMS recommends the web-based application for the fastest receipt of an NPI (CMS, how to apply), and CMS's prescriber guidance says the NPI is free of charge (CMS, NPI requirements for prescribers).
Individuals receive a Type 1 NPI, and an individual who is incorporated can also obtain a Type 2 NPI for the corporation or LLC (CMS, NPI fact sheet). Two application details come from Practice Better's NPI guide: your name on the application has to match your state license, and the taxonomy code you select identifies your specialty, so a wrong one can delay processing (Why, when, and how to get an NPI number). CMS publishes taxonomy codes for two of the license types on Medicare's list: 106H00000X for marriage and family therapists and 101YM0800X for mental health counselors (CMS, MFT and MHC enrollment FAQs).
An NPI leaves enrollment in each health plan as its own step. CMS states that holding one does not enroll you in a plan or guarantee payment by a plan (CMS, NPI fact sheet). Once you have one, CMS requires covered providers to report any change to NPI information within 30 days of the change (CMS, NPI fact sheet).
Register at CAQH, complete every section, upload your documents, and attest that the information is accurate. CAQH says the initial profile can take up to two hours (CAQH, getting started). The portal is free for providers, and health plans pay to use the data (CAQH, Provider Data Portal FAQs). CAQH's own site now calls the tool the Provider Data Portal, and Aetna's pages still refer to it as CAQH ProView, which is the name you will see in their instructions.
You decide who sees your profile. CAQH's quick reference says only you can authorize who has access to your information (CAQH, ProView quick reference), and Aetna's join page tells you to designate Aetna as an authorized health plan so it can access your application (Aetna, join the network). Add each payer you apply to.
Re-attest on schedule. CAQH requires attestation every 120 days, or every 180 days for Illinois providers, and a profile that misses the window moves to Expired status (CAQH, Provider Data Portal FAQs). Aetna's bulletin asks that your profile show a "Re-attestation" or "Initial Application Complete" status (Aetna provider education bulletin). Set a calendar reminder for the day you finish.
Start with the plans your current clients and waitlist carry, and apply to each payer through its own provider network page. On Aetna's form, the payer reviews the request and makes a decision within 60 days. If the panel is open and Aetna intends to pursue a contract, a network manager contacts you to start formal credentialing, and if the panel is not open you receive a denial by letter or email (Aetna, join the network). Aetna requires a separate application for each provider in a group (Aetna, join the network).
Aetna says it evaluates the current need to service its membership in your area before it decides whether contracting or credentialing applies (Aetna, join the network). After a closed-panel response, ask the payer whether and when the panel in your area reopens, and keep your other payer requests moving.
Choose a first round short enough to track by hand, so you can answer each payer's follow-up requests the day they arrive.
After a payer opens the door, it pulls your CAQH application and verifies it. Your job in this stage is to keep the profile attested and respond when the payer asks for something. Aetna's bulletin gives a contact route for any request that exceeds the published timelines (Aetna provider education bulletin), so write down the date you submitted and the date each stage should end. The next section lays out Aetna's stages.
Aetna sends its contract as an electronic document you sign through Adobe Sign, and after credentialing is approved it countersigns and returns the final contract (Aetna provider education bulletin). Before you sign any payer's contract, ask for the fee schedule that applies to you and compare the rate for each CPT code you plan to bill against what it costs you to deliver the session. Our guide to therapy billing codes covers the codes mental health practices use.
Ask for your participation effective date in writing. Aetna's bulletin says its systems reflect your participation effective date once the final contract is returned, and that you can submit claims from that point (Aetna provider education bulletin).
Credentialing continues after the effective date. CAQH requires re-attestation every 120 days, as covered in Step 2. For NPI changes, CMS requires covered providers to report any change within 30 days of the change (CMS, NPI fact sheet). Aetna says it uses CAQH for recredentialing as well, so your attestation schedule stays relevant after you join (Aetna, joining the provider network FAQs). Ask each payer for its recredentialing cycle and add the date to your calendar.
Aetna publishes the stage windows for its process, and they run through the 120-day mark. Other payers publish their own, so treat the table as one payer's worked example for planning.
| Stage on Aetna's schedule | Published window | What happens |
|---|---|---|
| Request for participation | 1 to 30 days | You complete the request, and Aetna emails you whether it intends to pursue a contract |
| Contracting | 30 to 60 days | The local network team begins contracting, and you sign electronically |
| Credentialing | 60 to 90 days | Aetna requests credentialing once it receives your signed contract and obtains your application from CAQH |
| Final contracting | 90 to 120 days | After approval, Aetna countersigns, shows your participation effective date, and you can submit claims |
Source: Aetna provider education bulletin, spring 2025. Aetna's join page gives its own decision window for the first stage, 60 days from your request (Aetna, join the network), so confirm your dates with the payer's staff once you apply.
If a plan publishes a schedule like this one, plan for the full span between your first request and your first billable session. The part you control is your own side of the file: a complete CAQH profile with the right status and authorization, matching names across your license, NPI and application, and prompt replies to requests.
Medicare handles provider participation through enrollment with CMS. The path for a therapist runs through an Identity & Access Management account, an NPI, and an application in PECOS (the online enrollment system) or a paper CMS-855I, submitted to your Medicare Administrative Contractor (CMS, MFT and MHC page). A separate CMS-855I enrollment is required in each state where you render services (CMS, MFT and MHC enrollment FAQs).
CMS's mental health booklet lists clinical psychologists and clinical social workers among the practitioners Medicare Part B covers (CMS, Medicare and mental health coverage). Effective January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare independently, paid at 75% of what a clinical psychologist receives under the Medicare Physician Fee Schedule (CMS, MFT and MHC page).
| License type | Qualifications CMS lists |
|---|---|
| Clinical psychologist | A psychology doctoral degree, and a license or certification at the independent level in the state where you practice |
| Clinical social worker | A social work master's or doctoral degree, at least 2 years of supervised clinical social work, and a state license or certification |
| Marriage and family therapist | A qualifying master's or doctor's degree, at least 2 years or 3,000 hours of post-master's supervised clinical experience, and a state license or certification |
| Mental health counselor | The same degree and experience requirements as an MFT, with a license or certification as a mental health counselor, clinical professional counselor, or professional counselor |
Sources: CMS, Medicare and mental health coverage for clinical psychologists and clinical social workers; CMS, MFT and MHC page for MFTs and MHCs.
Two details from CMS's MFT and MHC enrollment FAQs save time. MFTs and MHCs are limited-risk providers and pay no application fee. PECOS lists the MFT and MHC specialties, while the paper CMS-855I asks you to select the Undefined Non-Physician Practitioner option in section 2H and write in MFT or MHC (CMS, MFT and MHC enrollment FAQs).
A credentialing company completes the NPI, CAQH, and payer application work on your behalf, for a fee. Doing it yourself costs your time, since CAQH is free to providers (CAQH, Provider Data Portal FAQs) and so is the NPI (CMS, NPI requirements for prescribers). Any fee a service charges pays for its labor and expertise. The decision comes down to your answers to these questions:
If you hire a service, run these checks first:
Yes, as private-pay or out-of-network clients. Until a payer confirms your participation effective date, treat sessions as private-pay or out-of-network, as covered in Step 5. You can give clients a superbill after they pay you, and they submit it to their insurer for reimbursement if their policy allows (Your super guide to superbills). Tell new clients the status of each payer application in your intake materials, so nobody assumes you are in-network before you are.
These causes come from payer and CMS pages and from Practice Better's NPI guide:
The steps above happen on the CAQH site and on each payer's site. Once a payer confirms your effective date, the day-to-day work moves into billing: eligibility checks, claims, and rejections. Practice Better's billing and insurance page says US customers can check eligibility, submit claims, track status, manage rejections, and invoice clients for unpaid portions through the Claim.MD integration. It also says you can connect to Office Ally and more than 5,000 payers with format-ready CMS-1500 exports.
Without a Claim.MD account, you can still set up an insurance billing profile, export CMS-1500 claims, and send superbills, though claims are submitted outside Practice Better and you cannot track ERAs there (billing and insurance). Claim.MD requires its own account, and each practitioner on your team completes their own provider enrollment with Claim.MD before submitting claims (Claim.MD + Practice Better). Storing your NPI in your insurance billing profile includes it automatically on your CMS-1500 forms (Why, when, and how to get an NPI number). To add it, go to Settings (gear icon) > All Settings > Insurance Billing and enter your individual NPI in the My Profile section (setting up your insurance billing profile). For choosing a system for a therapy practice, see mental health practice management software and the Practice Better page for mental health professionals.
Start your free trial to set up your billing profile and superbills while your panel applications run.
{{claim-md-navattic-demo-simple-text}}
Each payer publishes its own stages. Aetna's provider bulletin labels the stages as 1 to 30 days, 30 to 60 days, 60 to 90 days, and 90 to 120 days, ending with a countersigned contract and a participation effective date (Aetna provider education bulletin, spring 2025). Ask each payer you apply to for its current windows.
Yes. Health plans, including Medicare, Medicaid, and private plans, require NPIs in their administrative and financial transactions, and an individual provider applies for a Type 1 NPI through NPPES (CMS, NPI fact sheet). CMS's prescriber guidance says the NPI is free of charge (CMS, NPI requirements for prescribers).
CAQH's Provider Data Portal is a platform where providers enter and verify professional information and share it with the organizations they authorize, and it is free for providers (CAQH, Provider Data Portal FAQs). Aetna says it uses CAQH ProView for credentialing and recredentialing (Aetna, joining the provider network FAQs). You re-attest every 120 days, or every 180 days in Illinois.
Medicare Part B covers clinical psychologists and clinical social workers, and since January 1, 2024 it also pays marriage and family therapists and mental health counselors, who qualify when they hold the required degree, supervised experience, and state license (CMS, MFT and MHC page). CMS's FAQs say a professional with a state title such as clinical professional counselor or professional counselor can enroll as a mental health counselor when the license meets the regulatory definition, and you enroll through PECOS or the CMS-855I (CMS, MFT and MHC enrollment FAQs).
Use one when the number of payers, the hours it takes, or your schedule makes the project cost more than the service's fee. CAQH and the NPI are free, so a fee pays for the service's labor. Keep your CAQH login in your own name, since only you can authorize who has access to your information (CAQH, ProView quick reference).
Yes, as private-pay or out-of-network clients. You give them a superbill after they pay you, and they submit it to their insurer for reimbursement if their policy allows (Your super guide to superbills). Aetna's bulletin says you can submit claims once your participation effective date is reflected in its systems (Aetna provider education bulletin).
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