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A provider can be licensed to see patients without being ready to bill payers. We synchronize CAQH profiles, primary-source verifications, and payer applications so you never lose claim revenue to credentialing gaps.
Complete billing readiness requires all three stages to be finalized.
We thoroughly validate your clinician’s professional background by verifying active state licenses and querying the National Practitioner Data Bank (NPDB).
We execute participating provider agreements between your practice and the health plan to establish your contracted reimbursement rates.
We link the individual rendering clinician’s Type 1 NPI to your group’s Type 2 NPI inside the payer’s claims engine so your claims can process.
Incomplete documentation packets cause 80% of payer application rejections. We audit every credentialing file before submitting it to health plans.
We need your individual Type 1 and Group Type 2 NPI confirmation letters with accurate 10-digit taxonomy codes.
We need current, unrestricted state clinical licenses for all practicing jurisdictions.
We need a current Certificate of Insurance showing individual or group coverage meeting commercial minimums.
We need a current resume detailing your complete professional history with written explanations for any employment gaps.
We need an active CAQH account with all educational transcripts and state disclosures fully populated.
We need a signed Form W-9 matching your legal practice name on file with the IRS.
Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealthcare. Turnaround depends on whether commercial network panels are open in your region.
Enrollment for eligible behavioral health practitioners (Clinical Psychologists, LCSWs, and psychiatrists) via the CMS PECOS portal.
State Medicaid agencies and Managed Care Organizations (MCOs). Requirements vary significantly by state credentialing bureaucracy.
Behavioral health credentialing carries unique regulatory nuances.
CMS enrollment via PECOS is strictly limited to specific behavioral disciplines (Psychologists, LCSWs, and Psychiatrists). LPCs and LMFTs follow distinct statutory guidelines and re-validation schedules.
State Medicaid plans frequently require specific rendering provider taxonomy codes and state credential modifiers (-HO for Master’s level clinicians) to be registered before claims process successfully.
If a commercial payer issues a "closed panel" rejection, MDRG submits network adequacy appeals highlighting specialized clinical competencies, language capabilities, or geographic coverage.
Many clinicians assume enrolling with commercial payers like BCBS or Aetna covers behavioral health encounters. In reality, providers must simultaneously enroll with separate carve-out entities (Optum BH, Carelon, Magellan).
A disciplined, step-by-step operational handoff that connects provider enrollment directly into your active billing schedule.
You provide provider credentials and CAQH access. We audit documentation for completeness and complete official CAQH re-attestation.
We prepare and submit enrollment applications across all selected health plans.
Our credentialing specialists follow up with payer enrollment departments every 14 to 21 days to resolve committee review requests.
Upon contract execution, we verify official in-network effective dates and activate billing schedules in your EHR.
Therapy and behavioral practices often struggle between overburdened in-house staff and software-only auto-submission. See how a dedicated behavioral RCM pod changes the financial equation.
| Billing Capability & Standard | In-House Clinic Biller | Software Auto-Submit | MD Revenue GroupDedicated Behavioral Pod |
|---|---|---|---|
Specialized AAPC Behavioral Coders Certified experts who know psychotherapy timestamp rules, add-ons, and ASAM levels | Costly & Hard to Find ($65k+/yr) | None (No Human Review) | Included (Dedicated Behavioral Pod) |
Pre-Submission Timestamp Scrubbing Verifying notes match start/stop times before claims leave to stop 90837 downcoding | Inconsistent / Manual | Not Checked (Blind EDI) | 100% Pre-Claim Audit |
Automated Carve-Out Payer Rerouting Identifying Optum BH, Carelon, and Magellan before submitting to primary clearinghouse | High Error Rate | Routes to Primary (Rejection) | Automated Crosswalk Routing |
Aggressive Denial Appeals SLA Formal clinical narrative appeals for unworked denials within 48 business hours | Often Backlogged / Abandoned | Clinician Must Appeal | 48-Hour Systematic SLA |
Practice Pricing & Risk Alignment Compensation model aligned directly with actual collections and financial performance | Fixed Salary, Taxes & Overhead | Monthly Fee Regardless of Pay | Performance-Based (2.99%–8.5%) |
Long-Term Contract Commitment Flexibility to evaluate partnership value monthly without restrictive lock-ins | Severance & Re-hiring Friction | Annual Platform Lock-In | Month-to-Month (Earned Trust) |
Once effective dates and rendering NPI links are active, we configure your clearinghouse and EHR billing portals so claims leave clean from Day 1.
We partner with practices that value complete documentation and proactive network management. Here is how we evaluate fit:
We do not hide behind anonymous offshore call centers or unverified software bots. MDRG provides direct access to credentialed revenue cycle managers and certified coding specialists.
Our coding and audit specialists maintain active credentials with the American Academy of Professional Coders (AAPC), ensuring precise CPT, ICD-10, and modifier application for behavioral healthcare encounters.
All data exchange, clearinghouse connections, and EHR interactions strictly adhere to HIPAA Omnibus standards, including 256-bit SSL encryption, restricted role-based access, and signed Business Associate Agreements (BAAs).
Founded by Faisal and Salwa in 2023 with over 13 years of combined revenue cycle leadership. Every practice has a named billing operations manager with direct phone and email escalation pathways.
Transparent month-end reporting on net collections, gross claims, denial categorization, and days in AR. We earn your partnership through monthly performance without restrictive multi-year lock-ins.
“Independent behavioral health clinicians should never have to sacrifice patient session time to battle commercial insurance clearinghouses. We treat your revenue cycle with the exact operational discipline you apply to patient care.”Faisal & Salwa — Founders, MD Revenue Group
Direct answers to common questions about behavioral health provider enrollment, CAQH attestations, effective dates, and panel closures.
Timing varies significantly by payer, state, provider discipline, application packet completeness, and whether the insurer requests additional documentation. Commercial plans typically take 60 to 90 days, while Medicare and Medicaid programs frequently require 60 to 120+ days. No reputable organization can guarantee a universal completion date.
Billing insurance before an official contract effective date is issued will trigger non-participating claim rejections that cannot be appealed. While some practices attempt "incident-to" or supervisory billing, commercial and Medicaid payers have strict rules prohibiting this for independent psychotherapy unless explicitly permitted by written contract.
CAQH ProView is the national online credentialing database used by almost all major commercial health plans to verify provider qualifications. Insurers require providers to re-attest their information every 90 days. If an attestation lapses, payers immediately pause application reviews or suspend active network participation.
If a payer indicates their network is full, MDRG drafts formal network adequacy appeals. We highlight your practice’s unique clinical services (e.g. child counseling, bilingual therapy, trauma care, weekend availability) or underserved geographic locations to secure an exception.
We manage ongoing roster maintenance: adding new incoming clinicians, re-credentialing established staff every 2 to 3 years, and properly offboarding departing clinicians so your practice directory remains accurate with insurance clearinghouses.
Yes. Our credentialing management system maintains active expiration tracking with automated 90-, 60-, and 30-day advance alerts for state licenses, DEA registrations, and malpractice policy renewals.
We offer credentialing both as an integrated component of our full-service revenue cycle management and as standalone per-provider/per-payer enrollment packages. See our credentialing overview or pricing page for detailed scope options.
No. Credentialing evaluations involve provider-level administrative data (NPIs, state licenses, active payer rosters, and CAQH profiles). Zero patient health information is ever requested or required.
Discover where unlinked NPIs, lapsed CAQH attestations, or missing payer contracts are delaying your practice’s billing cash flow. Zero patient data required.
Speak directly with an MDRG credentialing specialist about adding new clinicians, expanding into new insurance networks, or resolving CAQH backlogs. No sales pitch, zero claim data needed.
