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.

If you are considering credentialing with insurance payers, read this! Or share this with someone you know who might be interested in becoming and in-network provider. Insurance credentialing is nuanced, it's important to have clarity on what your practice goals are before starting the process. This is the #1 reason I encourage prospective clients to schedule a 15 minute consult with me before working together. Individual (Solo) Agreements vs. Group Contracts There are two wa

Many people ask me for EHR recommendations. In this post, I’ll break down the pros and cons of the platforms I’ve personally used, along with other popular EHRs commonly chosen by small to mid-sized behavioral health practices. I have extensive experience with both SimplePractice and TherapyNotes, and SimplePractice is the EHR I use in my own practice. SimplePractice Best suited for: Solo practitioners, counselors, and small group practices (approximately 2–10 providers) that

It’s very common for Kentucky providers to reach out for insurance credentialing and realize they don’t know their Kentucky Medicaid ID number — or aren’t even sure one exists. Your Kentucky Medicaid Provider ID is not publicly listed and isn’t something you can easily look up online. If you were enrolled in Kentucky Medicaid at any point, the ID must be requested directly from Kentucky Department for Medicaid Services (DMS) by the provider. For group practices or organizatio

These are some of the most common questions I get and things providers usually don’t know. And honestly, why would you? No one teaches this. These are just a few nuggets I’ve picked up over the last five years. Anthem requires CAQH re-attestation every 90 days. This is important for maintaining your in-network status. If you manage your own CAQH, set a reminder to re-attest every 90 days so this doesn’t get missed. Enrolling in Electronic Remittance Advice (ERA / 835 / paymen

(and Common Mistakes to Avoid) January brings more than new deductibles and insurance changes. It also marks the beginning of a new financial year for your practice—one that can either feel more organized and predictable, or more stressful and reactive, depending on what’s in place now. This post isn’t about filling out tax forms or giving financial advice. It’s about the systems and habits that make tax season easier and reduce unpleasant surprises later in the year. Whether

January marks a fresh start for many behavioral health practices—but it also brings a predictable financial and administrative shift: insurance deductibles reset on January 1st for most patients. While this reset is routine, its impact on practices can be significant if not planned for. Higher out-of-pocket costs for patients can lead to paused services, increased billing questions, and a heavier administrative load for practice owners. Without clear systems in place, these f

Insurance credentialing can feel deceptively administrative—until you’re in it. Missing information, unclear business structure, or incomplete documentation can delay credentialing for months and directly impact when (or if) you get paid. Whether you’re opening a private practice, joining a group, or expanding services, having the right information ready ahead of time can make credentialing far smoother. Below is a practical guide to what to have in place before you start the

Setting yourself up for a smoother, stronger year ahead As the year comes to a close, private practice owners often find themselves juggling clinical responsibilities while also trying to tie up loose ends on the business side. A thoughtful year-end review not only keeps your practice compliant and financially healthy—it gives you a clean slate to step into the new year with clarity, confidence, and intention. Below is a practical year-end checklist to help behavioral health