Contracting & Credentialing Services
Whether you are a Behavior Analyst starting your own practice, or an established clinic looking to credential newly hired BCBAs, TLC Credentialing & Consulting can take care of your credentialing needs. We also provide credentialing services for mental health (LCSW, LPC, LMFT) practitioners, occupational therapy and speech therapy.
We provide contracting and credentialing services for major nationwide payors (Aetna, Evernorth/Cigna, Optum/United Healthcare, Beacon/Carelon, Magellan, Humana, Tricare) and state specific payors (Blue Cross Blue Shield, Anthem BCBS, Medicaid). Medicaid credentialing is not available in all states - please contact us to inquire if we work with Medicaid in your state.
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How It Works
1. Submit an inquiry through our website or call 512.815.3242. Provide the state(s) you practice in, the number of BCBAs you wish to credential and the payors you wish to credential them with.
2. We will arrange a free 30 minute introductory call. During this call, we will discuss the payors you wish to work with, any limitations and pricing.
3. We will send you an invoice for the services agreed upon during the introductory call, as well as a contract for your signature.
4. Half of the total cost will be due before we can get started on your credentialing. The other half will be due upon completion. We must receive the signed contract and the first payment before we can begin any work.
5. Upon receiving the first half of your payment and signed contract, we will send you intake paperwork. This will be how you provide information required to credential your providers (provider names, NPIs, TIN, practice address(es), etc). You will also need to provide your W-9 and a copy of your professional liability insurance. Depending on the payors you choose, you may also need to provider a CV, copy of a criminal background check and your IRS 147c or IRS 575 letter (letter issued when your TIN is established).
6. Upon receiving your completed intake paperwork, your submission will be reviewed for accuracy and completeness. Assuming we have all of the information your payors require, we will begin your credentialing within 2 business days of receipt of your completed paperwork.
7. Now you wait! Contracting can take 6 months+ and credentialing can take anywhere from 60-180 days, depending on the payor. During this time, TLC will be calling/emailing your payors to follow-up on the status of your application. We will contact you if they require any additional information or signatures from you. If you are obtaining an initial contract with the payor, you will be given the rates they proposed and an opportunity to negotiate the rates before signing.
8. It is VERY IMPORTANT that the CAQH profile(s) for all providers are kept up to date and attested during this waiting period. TLC will not be responsible for credentialing applications that are delayed or voided due to the CAQH profile needing to be updated. It is also very important that you make TLC aware of any attempt of the payor to contact you directly so we can respond. Any application voided because of an out of date CAQH or non-response to correspondence not received by TLC will have to be resubmitted and you will have to pay an additional fee. TLC does not make any updates to CAQH profiles, but we do provide training on how to complete a profile.
8. Once your contract/credentialing has been approved, TLC will provide you with written confirmation of approval. You will then be invoiced for the remaining portion of the cost and payment will be due within 14 calendar days.
For FAQs and general information on the credentialing process, click here.
For FAQs related to TLC Credentialing and Consulting policies and procedures, click here.