DENVER - In recent months, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has received an increasing number of complaints from behavioral health providers experiencing barriers to enter and participate in Colorado insurance companies’ health care provider networks. The use of pre-licensed behavioral health candidates is a strategy to mitigate the shortage of behavioral health providers throughout the state. The complaints received by the DOI indicate the challenges preventing the successful use of this strategy.
In addition to provider complaints, the DOI receives complaints from consumers reporting they could not receive in-network behavioral health services using their insurance. Both types of complaints illustrate the need to increase the number of in-network providers while streamlining processes to reduce network admission timelines. According to the 2021 Colorado Health Access Survey, 44% of Coloradans with commercial health insurance did not get the mental health care they needed because they had a hard time getting an appointment.
In response to these issues, the DOI issued Bulletin (B-4.131) on June 6, 2023, directing Colorado insurance companies to adopt credentialing standards that expedite the process and reduce unnecessary administrative burdens for behavioral health providers. Companies were also strongly encouraged to allow reimbursement of claims by pre-license and provisional behavioral health candidates, an approach that may increase the number of available, in-network providers and improve Coloradans’ access to behavioral health care.
Survey of Insurance Companies on Credentialing and Billing Policies
In addition to the published bulletin, the DOI requested information from health insurance companies for information about their credentialing and billing policies for these types of health care providers. Below is a summary of the insurance companies’ responses. The DOI has created a website listing these responses from the insurance companies, detailing which company does or doesn’t allow these processes - Commercial Insurance Resources for Behavioral Health Providers in Colorado.
Terminology
- Pre-Licensure Billing: allowable billing and reimbursement for services provided by doctorate or masters level clinical mental health, behavioral health, and substance use disorder (SUD) providers who are under the supervision of a fully licensed. contracted provider.
- Provisional Credentialing: granting short-term, in-network status to mental health, behavioral health, and SUD providers to provide care to members while the entire credentialing process is completed.
- Delegated Credentialing: granting a providing entity the authority to credential its mental health, behavioral health, and substance use practitioners.
Summary of Responses
- 11 out of 18 companies allow for billing and reimbursement of a pre-licensed behavioral health provider candidate under the supervision of a licensed behavioral health provider
- 2 out of 18 companies allow for provisional billing and reimbursement of a licensed behavioral health provider
- 14 out of 18 companies allow for delegated credentialing of behavioral health providers
Where can providers submit complaints and concerns?
Should behavioral health providers or candidates find that their actual experience differs from a company’s response as listed on the Commercial Insurance Resources for Behavioral Health Providers in Colorado website, or have other complaints about Colorado health insurers, the DOI asks that they submit their concerns and complaints at dora_bh_provider_issues@state.co.us.
Questions or Concerns? Contact the Division of Insurance
Consumers with questions or concerns should contact the Division’s Consumer Services Team - 303-894-7490 / DORA_Insurance@state.co.us/ doi.colorado.gov (click “File a Complaint”).
The DOI is committed to ensuring Colorado consumers have access to the mental health care they need through adequate networks. Ensuring insurance companies expedite credentialing, billing and reimbursement for mental, behavioral and substance use disorder providers will be an ongoing process at the DOI.
For more information visit the DOI Mental / Behavioral Health website.