Enrolled for outpatient, billing for residential
Payers contract by level of care. A facility credentialed for IOP that bills residential days is denied, and the residential contract takes months to add.
Provider credentialing
Substance Abuse Treatment Facility Credentialing
Addiction treatment programs are credentialed at the facility level for each level of care, with state licensure and accreditation as prerequisites and each clinician credentialed underneath. We enroll treatment programs with Medicaid and commercial behavioral networks and keep the clinician roster current.
- Contracts by level of care
- State license and accreditation first
- Medicaid provider types by state
- Clinicians rostered and credentialed
- Timeline for a new program: up to a year
7-14 daysto onboard your practice end to end
Weeklystatus report on every open application
50 statesMedicare, Medicaid and commercial panels
A substance use treatment organization may operate detox, residential, partial hospitalization, intensive outpatient and outpatient levels of care, and payers credential each level separately, often requiring a state license for each and accreditation by CARF or the Joint Commission. Medicaid enrollment follows state behavioral health provider type rules, and commercial behavioral networks contract by level of care with their own utilization management.
ClainetRCM sequences facility licensure, accreditation and enrollment so each level of care becomes payable as it opens, credentials the physicians, NPs, counselors and therapists who deliver the care, and manages the roster and re-credentialing on every payer's cycle.
Where this usually goes wrong
Accreditation started too late
Most commercial behavioral networks require accreditation before contracting. Programs that apply first and accredit later lose a full cycle.
Counselors without accepted credentials
Payers accept specific license types for substance use counseling and reject others. Rostering staff who do not meet the standard leads to denied services.
What ClainetRCM handles for you
One coordinator owns every file from intake to effective date.
- Level-of-care licensure and accreditation roadmap with dependencies and timelines
- Facility enrollment with state Medicaid and behavioral health MCOs under each level of care
- Commercial behavioral network contracts by level of care with utilization management setup
- Clinician credentialing for physicians, NPs, psychologists, therapists and licensed counselors
- Medicare enrollment for physicians and eligible clinicians, and for opioid treatment programs
- Roster maintenance, re-credentialing and accreditation renewal tracking
Credentialing by level of care
Detox and residential
State facility license, accreditation, and per-diem contracts with commercial behavioral networks; Medicaid coverage depends on state waivers.
PHP and IOP
Program licensure, accreditation and per-diem or per-session contracts; heavy utilization review.
Outpatient
Clinic enrollment with clinician linkage. See mental health credentialing.
Opioid treatment programs
SAMHSA certification, DEA registration and Medicare OTP enrollment.
Clinicians
Physicians, NPs and therapists credentialed individually. See therapist credentialing.
How the work runs
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Frequently asked questions
Commercial behavioral network contracts typically take 120 to 180 days after accreditation, and Medicaid enrollment 60 to 120 days depending on the state. Accreditation itself can take six months or more, so the total timeline for a new program is often a year.
For most commercial behavioral networks, yes, at the residential, PHP and IOP levels. Some Medicaid programs accept state licensure alone. We map the requirements for each target payer before you invest in accreditation.
Physicians, NPs and eligible clinicians can bill Medicare for covered services, and opioid treatment programs have a specific Medicare benefit. Residential treatment is generally not a Medicare benefit outside hospital settings.
Yes. Facility contracts require each rendering clinician to be credentialed and rostered. We manage the roster as staff change so services remain billable.
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.