Leaving a therapy network
Run the numbers before you contract directly
Therapy networks credential you with payers and pay you per session, and some deduct a fee from every session. Contracting directly keeps the whole rate but means running your own billing. Put in your own figures to see which keeps you more each month.
Monthly comparison
- Kept on the network
- $0.00
- Kept contracting directly
- $0.00
- Difference per month
- $0.00
- Sessions a month where direct starts keeping more
- At these rates a direct session keeps no more than a network session, so no caseload makes direct contracting pay.
Contracting directly: the steps
1. Keep your provider identity current
Your individual NPI, your practice NPI if you bill as a group, your taxonomy code and your CAQH profile, re-attested on schedule. Payers read all of them during credentialing.
2. Apply to each payer you want in network
Each payer credentials and contracts separately. Ask each for its application, its fee schedule for your codes and your effective date, and do not see its members until the contract is effective.
3. Enroll for claims and payments
Enroll with a clearinghouse for electronic claims, and with each payer for electronic remittance (ERA) and direct deposit (EFT), so payments arrive and post themselves.
4. Take your records with you
Export your notes, treatment plans and client contact details from the network before your access ends, and keep them as your record retention rules require.
5. Tell your clients what changes
Who bills them, what their plan covers out of network until you are contracted, and when you will be in network. Clients whose plans you will not contract with need a referral or a self-pay option.
6. Plan the overlap
Until each contract is effective, sessions with that payer's members still go through the network or are billed out of network. Leave the network only when your contracts cover your caseload.