Resources
Guides for running and growing your practice
Practical guides written from our medical billing, credentialing and practice operations work, plus the checklists and official sources we rely on ourselves.
Forms And Official Portals
The official forms and portals you will use for credentialing and enrollment. Links to other sites open in a new tab.
CMS-855I Medicare Enrollment Application
The Medicare enrollment application for an individual clinician, including reassigning benefits to a group.
CMS-855B Medicare Enrollment Application
The Medicare enrollment application for a group practice or clinic.
CMS-588 Electronic Funds Transfer Authorization
The form that sets up electronic funds transfer so Medicare payments land in your bank account.
CMS Identity And Access Management
The CMS account you create to use PECOS and to let someone else file for you.
DataSpring Provider Data Portal (formerly CAQH)
Where you keep and attest the profile many commercial payers use to credential you.
Availity Essentials Registration
The web portal many health plans use for claims, eligibility and some enrollment work.
Your State Medicaid Portal
Most state credentialing pages link their Medicaid provider enrollment portal.Credentialing Preparation Checklist
What to gather before you apply, in the order we work.Featured guide
From Headway or Rula to your own practice: credentialing and contracts
Understand what changes when you establish your own payer relationships, from Tax IDs and organizational NPIs to contracts, directory listings, and payment setup.
Starting your own practice
Leaving Rula, Headway, Grow or Alma? What happens to your insurance contracts
What each platform says about whose contract you’re under today, what stays with you, if you can build your own contracts while you stay, and how long they take.
Headway vs Alma vs private practice: a PMHNP comparison
A neutral look at billing through a platform versus holding your own payer contracts, with the real pros and cons and how to plan the switch before you change billing.
How to start a PMHNP private practice: 2026 step by step
Your state’s practice rules, the business setup, EIN and NPIs, malpractice and early credentialing, in the order they need to happen, with a realistic solo launch cost breakdown.
PMHNP scope of practice by state: full practice authority
Full, reduced and restricted practice explained, what a collaborative agreement involves, and links to each state board so you can confirm your own rules.
New practice billing setup: what to finish before your first claim
The provider, payer, patient, coding and submission details to confirm before real claims go out, because a clean clearinghouse transmission doesn’t prove a payer accepted anything.
Credentialing and enrollment
How long does credentialing take? Published timelines by payer and state (2026)
What UnitedHealthcare, Evernorth, Anthem, the Blue plans, Medicare and Medicaid publish, the 31 states with a deadline in law, and why we plan on 60 to 120 days per payer.
Credentialing status explained: submitted, approved, effective, EFT and ERA
What each status really confirms between “submitted” and a first paid claim, and what to document before you treat a payer as finished.
Why credentialing takes so long, and what speeds it up
The delays you can control, like documents that aren’t ready, applications nobody tracks and a CAQH attestation that lapses partway through, and what each one costs a practice.
CAQH is now DataSpring: Provider Data Portal setup and attestation, step by step
How to set up and attest the profile most commercial payers pull from, the documents to have ready, and the mistakes that stall behavioral health files.
Group practice credentialing: group contracts, Type 2 NPIs and adding clinicians
The two tracks every group runs, what the group sets up once and what each new clinician needs, with a 120 day hiring plan and the roster updates payers expect.
Credentialing in multiple states: a telehealth practice’s guide (2026)
Why a license or compact privilege doesn’t put you into a payer network, how Medicaid and commercial plans handle out of state telehealth, and which states to add first.
Medicare enrollment for counselors and MFTs (LPC, LMHC, LMFT): 2026 step by step
Who qualifies now that Medicare covers counselors and MFTs, the PECOS steps, which MAC processes your file, effective dates and what Medicare pays.
Getting paid while credentialing is pending: Oregon and the western states
Oregon gives PPO and managed care insurers 90 days to decide on a complete application and requires payment for covered care during the wait. How Washington, California and the rest of the West compare.
PMHNP credentialing and insurance enrollment: 2026 guide
CAQH/DataSpring, Medicare through PECOS, state Medicaid and commercial applications for psychiatric nurse practitioners, with realistic payer timelines and where PMHNPs lose months.
Billing and coding
Behavioral health CPT and billing code reference
The evaluation, psychotherapy, E/M, crisis, testing and collaborative care codes most behavioral health claims use, plus telehealth modifiers and filing limits by payer type.
90834 vs 90837: choosing the right psychotherapy code (and the add-on codes)
Documented session time picks the code: 90834 covers 38 to 52 minutes and 90837 starts at 53. What your note needs to show, and how therapy codes pair with medication management.
PMHNP billing and coding: the complete 2026 guide
Billing under your own NPI or incident to a physician, the CPT codes PMHNPs use most, Medicare’s 85% rate when you bill directly, and the denial reasons to watch.
Telehealth billing modifiers for behavioral health: 95, 93, GT and POS 02 vs 10
Modifiers describe how the visit happened and the place of service describes where the patient was. A four part check before you change a claim, plus Medicare’s separate rules.
Timely filing limits for behavioral health claims
Medicare’s 12 month limit, the usual commercial and Medicaid windows, why claims miss the deadline and how to appeal a CO-29 denial.
IOP vs PHP billing in behavioral health: codes, differences and denials
Why intensive outpatient and partial hospitalization are authorized, coded and paid on separate tracks, and the mismatches that lead to denials or clawbacks.
TMS billing: CPT 90867, 90868 and 90869 explained for psychiatry practices
What each TMS code covers, the Medicare and commercial authorization rules, how to count units across a course and why TMS claims deny.
Spravato (esketamine) billing: a practical guide for behavioral health practices
The two billing models payers use, Medicare’s bundled G codes or J0013 with a separate E/M visit, and the REMS and authorization steps to settle before the first dose.
Billing Oregon’s behavioral health payers: Providence, Moda, PacificSource and OHP
How Oregon’s major commercial plans and the Oregon Health Plan CCOs differ, a repeatable workflow for any Oregon payer, and where claims usually go wrong.
Denials and A/R
Denial management workflow for healthcare practices
Sort every denial by reason code, give each one an owner and a next action date, and trace repeats back to the step that caused them so the same CO-27 stops coming back.
A denial management playbook for behavioral health: the codes behind the denials
How to read the CARC and RARC codes behind common denials, like CO-16 and CO-197, triage by what can actually be recovered, and decide where an appeal is worth it.
What causes an A/R backlog in healthcare billing
The eight causes we see most, from eligibility nobody rechecked to posting that runs days behind, and a 90 day plan to bring unpaid claims down.
Weekly A/R review for behavioral health practices: what to check
A 20 minute owner agenda across seven areas, so every unpaid balance is moving toward payment, a documented payer decision, a corrected claim or a deliberate write off.
Mental health billing mistakes that slow down reimbursement
The eight we see most, like a 60 minute session billed as 90834 or a telehealth claim missing modifier 95, and a 30 minute audit to find them in your own claims.
Behavioral health revenue leakage: where the money is lost outside billing
Why most lost revenue goes missing before the claim, with a wrong subscriber ID, a provider who isn’t enrolled yet or an unsigned note, and why replacing a biller or EHR may not fix it.
Running and growing a practice
Solo to group practice: what changes when you add your first provider
The provider, payer, billing, access and daily workflow setup to finish before a new clinician sees a single patient, with a simple readiness table.
Clinic handoff checklist for growing behavioral health practices
How to follow the work that keeps landing back on the owner, fix the handoff where it breaks, and check the repair two weeks later.
Clinic policy and procedure control for behavioral health practices
One current copy, one owner and the right access for each job, with a policy library checklist so staff stop working from copies saved to their desktops.
EHR optimization vs replacement
Before you replace your EHR, find out whether the problem is the software or how it’s set up. Four questions to answer with evidence, and the costs to budget beyond the contract.
Switching EHRs: what behavioral health practices need to know before they sign
Build the conversion manifest first, read both contracts as operating documents, run a test conversion and plan the billing cutover on its own, with a printable checklist.
Newer posts also appear on the blog.
Checklists and tools
Working tools you can use on your own, and a printable checklist we email to you.
The behavioral health provider credentialing checklist
The order we work in, from your NPI and CAQH/DataSpring profile to each commercial application, with the documents to gather first and what keeps you credentialed after approval.
Denial follow-up worksheet
Give each denial an owner, a next step and an escalation date, so your team always knows what to work next.
Credentialing delay cost calculator
Enter your providers, weekly sessions and average reimbursement to see what each month of credentialing delay costs in revenue you can’t bill.
The Behavioral Health Credentialing Checklist
Five pages: every document payers ask for, the CAQH/DataSpring steps that stall files, how to pick payers, a renewal calendar and a payer tracker you can fill in. We email it to you right away.
Official sources
The agency sites we check ourselves. Each one opens in a new tab.
CMS Medicare Learning Network
Medicare billing and coding education, booklets and fact sheets.
CMS NCCI edits
The code pair and modifier edits Medicare applies to claims.
CMS Physician Fee Schedule search
Look up Medicare rates by code and locality.
DataSpring Provider Data Portal (formerly CAQH)
Where you keep and attest the profile most commercial payers use for credentialing.
PECOS
Medicare provider enrollment, changes and revalidation.
NPPES
Apply for or update a Type 1 or Type 2 NPI.
See Services And Prices
Most of our services have published prices. Larger or more complex setups and ongoing partnerships get a written scope and price before they start.