Learning & Resources for Organizations

Adding a provider to your practice usually means you're growing. But before you give them a start date and start putting patients on their schedule, there are several things you need to have in place. Your provider needs to know what is expected of them, what they are responsible for, what the practice is responsible for, and who handles what. That starts with a solid onboarding process. Here’s what you need to have in place before your next provider starts. Start with the lo

One of the biggest misconceptions I see is that once you're approved with an insurance company, you can immediately start billing. That's not always the case. This only applies to new contracts and newly credentialed providers. For new contracts, most insurance companies have a separate loading process that happens after your credentialing has been approved. During this process, they add your information to their claims system, including your NPI, Tax ID, practice informatio

The first question I ask clients is do they want to have the flexibility to add/credential another provider with their practice at any point in the future. This guides us to determine what the next steps are and how they should credential their practice. If the answer is yes, then we need to make sure they have a group NPI. The group NPI When you credential with the insurance payers, you can enter into a contract using your Individual NPI (type 1): Individual/solo agreement O

If you're credentialed with insurance companies, you've probably started seeing references to DataSpring. That's because CAQH has officially rebranded. The good news: from a provider perspective, nothing is changing operationally. DataSpring is still the platform insurance companies use to obtain provider information for credentialing, enrollment, provider directories, and other administrative functions. Your login, profile, attestation process, and workflows remain the same.

Managing payer enrollment, credentialing, billing, and prior authorizations requires access to multiple provider systems. Below is a consolidated list of commonly used portals and resources for behavioral health providers in Kentucky. TriCare East TriCare East Provider Portal Used for: Provider enrollment and account management Claims and eligibility Authorizations Patient benefit verification Medicare Identity & Access (I&A) Management System Required to: Create and manage M

The Kentucky Department for Medicaid Services released an updated fee schedule on April 1st, 2026. Access the updated fee schedule here: Take note that the rates increased. MCO's and DMS should pay the new rate effective, April 1st, 2026. If you are still being reimbursed for services at the old rate, I'd recommend contacting the MCO provider rep and requesting they do a claim sweep back to 4/1/26 to reprocess all claims. Access contact information for the provider reps here:

Center for Medicare and Medicaid Services (CMS) Place of Service Codes: What Are Place of Service Codes Place of Service codes are two-digit codes used on professional claims to indicate where a service was delivered. (Centers for Medicare & Medicaid Services) They are maintained by the Centers for Medicare & Medicaid Services and are required under HIPAA standard transactions for claims submission. (Centers for Medicare & Medicaid Services) Each code corresponds to a specifi

There are separate processes for submitting complaints depending on the payer type. Managed Care Organization (MCO) issues are handled through the Kentucky Department of Medicaid, while complaints involving commercial payers are submitted through the Kentucky Department of Insurance. Both processes are outlined below. When to Submit a Complaint to KY Dept of Insurance and KY Dept of Medicaid Services Submit a complaint when there is evidence of: Unreasonable claim delays Cla

Effective July 15th, 2026 per house Bill 470: Code H2027 (Psychoeducation) is no longer billable/reimbursable by KY Medicaid and MCO's Psychoeducation (H2027) is a covered behavioral health service under Kentucky Medicaid. It is defined as a direct, planned, and structured intervention that involves presenting or demonstrating information to an individual and, when appropriate, their family or support system. This overview outlines what the service includes, how it is used, a

EFT enrollments are an important part to streamlining billing. I've had several clients reach out to me recently stating they are receiving a virtual card from the insurance payer and are unsure about how to enroll in EFT. In this post, I will share links for completing EFT enrollment for each common payer in Kentucky. A big part of what I do is to help alleviate administrative burden placed on behavioral health providers and group practices. If you are credentialed but not e

Most providers say they want to “network.” That’s not the issue. The issue is lack of structure. Referrals increase when there is a clear system tied to the right sources. Start With Where Referrals Actually Come From Referrals are concentrated: Primary care offices Medicaid MCO care coordinators (Passport, WellCare, Aetna, Humana, Anthem) Schools Substance use programs Attorneys Community organizations, especially in rural areas For self-pay: Existing client word-of-mouth Ot

Not all professional liability insurance carriers are the same. This post compares five of the most common carriers used by mental health professionals — CPH & Associates, HPSO, CM&F Group, American Professional Agency, and Preferra — with a focus on coverage differences, free legal consultation, and which carriers explicitly instruct policyholders to contact them when subpoenaed.