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  • National provider identification (NPI): The NPI number is a ten-digit identification number, associated with individual physicians, including both solo and group practices.

 

  • Board Practitioner License(s): An active medical license is required for every state in which you are practicing or intend to practice medicine. A list of previous or inactive medical licenses may also be requested.

 

  • Malpractice Insurance (Certificate of Insurance): Medical malpractice insurance protects healthcare professionals against claims alleging their negligent acts caused injury to patients.

 

  • DEA (federal) certificate and CDS (state) certificate.​

 

  • Copy of highest level of education/ Diploma (required for non-MD’s, DO’s)
     

  • Updated CV: Make sure that you organized it chronologically and included crucial data like demographic, education and licensure, awards and honors, practice history and hospital affiliations, and peer-reviewed publications or presentations.

 

  • IRS Form W-9

 

  • Current driver’s license: A passport or other government-issued identification is an acceptable alternative. A passport-sized professional photograph may be requested to present in the early stage of your application.

 

  • Your Legal Entity​

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  • Business License

 

  • Copy of office lease (required for therapy facilities)

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Frequently Asked Questions

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What is insurance credentialing?

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Insurance Credentialing is the process of becoming affiliated with insurance companies. This allows a mental healthcare provider to accept third party reimbursement. 

Can you guarantee I will be accepted?

If you are fully licensed, there should be no problem locating insurance companies and third party payers for you to be credentialed with.

Is there a contract between insurance companies and providers?

Yes, you have to agree to the terms and conditions in order to be an In Network provider.

Which Insurance panels are best for me?

Our Specialist will help you decide which panels will best fit your practice.

Are EAP’s (Employee Assistance Programs) part of the credentialing process?

An Employee Assistance Program (EAP), is provided by your employer. An EAP is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems. EAPs have trained representatives that can evaluate the needs of the employee and connect them to the best resource to help with that need.

How long do insurance reimbursements typically take?

In most cases, it will take at least 30 days from the date the insurer receives a claim to when your mental health practice will receive reimbursement

Why should I outsource my billing?

Increased revenue, professional billing and coding companies have the experience and knowledge to optimize the billing process, leading to fewer claim denials and quicker reimbursements.

What is CalAIM and how does it impact behavioral health providers?

CalAIM (California Advancing and Innovating Medi-Cal) is a statewide initiative to improve Medi-Cal services by focusing on whole-person care, equity, and access. For behavioral health providers, this means expanded reimbursement opportunities, new reporting requirements, and a stronger emphasis on integrated care.

How can providers prepare for CalAIM changes?

Providers should review their credentialing, billing, and compliance processes to ensure they align with CalAIM requirements. Partnering with an experienced billing and credentialing specialist can help providers stay current, avoid revenue loss, and maximize reimbursement under the new guidelines.

Therapists Insurance & Revenue:

Am I on the right insurance panels to reach my target clients, or should I expand my credentialing to increase revenue opportunities?

Do you have an AI consent form to share with your clients?

If you are using any AI-assisted tools in your practice (such as documentation support, billing review, or scheduling software with AI features), it is important to provide your clients with a clear AI consent form. This form should explain how AI may be used, what safeguards are in place to protect their PHI, and give them the option to opt in or opt out. If you do not yet have one, Open Door Billing can provide a template to help you stay compliant and transparent with your clients.

Do I have a clear understanding of my reimbursement rates, claim denials, and revenue cycle — and how they impact my long-term financial sustainability?

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