Key takeaways
- A behavioral health group started with us with one provider and grew over three years to more than 100 providers in 20 states.
- At one point, with 54 active providers, we were managing more than 1,720 active payer enrollments for the group.
- By the time the group reached 100 providers, we had processed and submitted more than 3,000 payer applications for it.
- At this scale the main challenge is administrative: every new provider, state and payer adds enrollments that have to be tracked until they are active.
- Results vary by group, payer and state.
The situation
A behavioral health group started working with us with a single provider. Growing a behavioral health group is administratively heavy. Each new clinician needs a license, a current CAQH profile and an enrollment with every payer the group wants to accept, and each new state brings its own licensing board, Medicaid program and mix of payers.
The group is anonymized here, and no patient, provider or payer-specific details are shared.
What we did
We managed the group’s provider credentialing and payer enrollment as it grew. In general terms, that meant:
- Keeping one provider-by-payer tracker for the whole group, so every application and effective date was visible in one place.
- Following each application to a confirmed effective date, instead of stopping at submission.
- Tracking re-credentialing, revalidation and attestation dates so enrollments did not lapse as the roster grew.
- Working with the group’s leadership on each new provider and each new state before applications went out.
The result
Over three years, the group grew from one provider to more than 100 providers across 20 states. At one point, when the group had 54 active providers, we were managing more than 1,720 active payer enrollments for them. By the time it reached 100 providers, we had processed and submitted more than 3,000 payer applications.
What this shows
Scaling a behavioral health group is an administrative problem before it is a revenue problem. A provider can only bill a payer once enrollment is active with a confirmed effective date, so growth depends on how well enrollments are tracked. In our experience, groups that grow cleanly treat enrollment as one connected system instead of a series of separate applications.
Frequently asked questions
What is the difference between a payer application and an active payer enrollment?
One provider enrolled with one payer counts as one enrollment. An application is the request that leads to an enrollment, so the number of applications submitted is higher than the number of enrollments active at any one time. Both totals grow with every provider and every payer added.
Can MedWork Services support multi-state behavioral health groups?
Yes. We support administrative coordination across all 50 states, subject to each state’s, profession’s and payer’s requirements. Results vary by group, payer and state.
Where should a growing group start?
With a provider-by-payer view of what is active, what is pending and what has no confirmed effective date. Everything else depends on that.
Planning to add providers or states?
We can review your enrollment plan and timeline before you grow.
The initial audit is complimentary.
Related reading: Case Study: Managing Billing and RCM for a Growing Behavioral Health Practice · How Long Does Provider Enrollment Really Take?
About the author
Kamran Muzaffar is the founder of MedWork Services and has 12 years of experience in healthcare revenue operations. He oversees the Billing, Credentialing and Licensing departments and works directly with providers on enrollment and revenue recovery.
General information only. Payer rules and regulations change, so confirm current requirements for your situation.