The Importance of Health Care Credentialing in Behavioral Health

Doctors using their laptops

Behavioral health and human services professionals not only perform essential services for patients and clientele, but they also have a strong duty to provide acceptable, if not exemplary, care for those patients.

Part of providing the best patient care is choosing qualified health care providers. When hiring behavioral health care employees, organizations must carry out all of the standard steps, such as reviewing the candidate’s work history and conducting a background check. However, there’s another very important step that cannot be ignored: reviewing licenses or certifications to determine an applicant’s eligibility for specific roles.

Learn why health care credentialing is so important and how behavioral health organizations can simplify the credential management process.

Health Care Credentialing: Why It Matters

Keeping track of an employee’s license status is a crucial aspect of HR management for behavioral health and human services organizations. There are a number of issues that these agencies may encounter if an employee provides medical services or conducts other regulated work without the appropriate credentials. 

Possible consequences of having employees work without valid health care credentialing include:

  • Rejected Insurance Claims: Insurance companies, including Medicare and Medicaid, may reject health plan insurance claims if the health care provider that performed the service did not have the correct medical credentialing. Reimbursement rates are already often lower for behavioral health organizations than other medical providers, which has created ongoing funding issues in the field. As such, the lost revenue for rejected health insurance claims can seriously impact an organization’s finances.
  • Longer Wait Times for Re-Credentialing: The credentialing process varies by state for each license, as does the renewal process. However, it’s worth noting that many states and licensing boards require professionals that let their licenses expire to go through the entire credentialing application process again rather than the renewal process. This often requires more paperwork and may require an examination. Some licensing bodies provide a grace period for those renewing expired licenses, but it’s best to ensure that employees renew on time to avoid potential delays.
  • Lawsuits and Liability: Health care organizations must always be cautious of possible accusations of malpractice or legal non-compliance. Allowing health care professionals to practice without up-to-date credentials can open up a company to possible legal liability.
  • Loss of Trust From Patients: Patients trust health care facilities to provide high-quality care from qualified staff. If they find out that a member of the treatment team does not have valid credentials, they can lose trust in the entire organization.

Common Credentials for Behavioral Health Professionals

Healthcare credentialing: psychiatrist talking to his patient

Health care credentials verify that medical staff and other behavioral health providers possess the required education and competencies to properly serve patients. Here are some of the common types of licenses or credentials for workers in the behavioral health care industry.

Registered Nurse (RN)

Licensed registered nurses provide nursing services and health education to patients. Behavioral health organizations often employ psychiatric nurses with RN licenses. To become licensed as an RN, candidates must have an approved associate’s degree, bachelor’s degree, or diploma in nursing and pass the NCLEX-RN or NCLEX-PN exam. 

In some states, a criminal background check is also required, as is an application fee. Continuing education is typically required between license renewals, although the specific number of credits or hours required will vary by state.

Licensed Clinical Social Worker (LCSW)

The licensed clinical social worker credential is required licensure for social workers. Social workers can take on a number of different roles in behavioral health, including maintaining child welfare, helping patients access community support services, advocating for patients, overseeing group treatment activities, and more. LCSW licensing also allows candidates to provide counseling services.

To obtain an LCSW credential, a candidate must complete a master’s in social work, obtain the required number of supervised experience hours, and pass an exam. Once licensed, continuing education is required to renew the LCSW license. Requirements for experience hours and continuing education vary by state.

Licensed Marriage and Family Therapist (LMFT)

Practitioners with an LMFT credential can provide counseling to individuals, couples, and families. They do not diagnose conditions but can utilize therapy techniques including cognitive behavioral therapy and dialectical behavioral therapy to help patients navigate emotional challenges and learn coping skills.

LMFT licensees need to earn a master’s degree in Marriage and Family Therapy, complete supervised experience hours, and pass an exam. Continuing education is required to maintain the license.

Licensed Psychologist

Psychologists provide talk therapy and also make diagnoses. However, they cannot prescribe medication. Psychologists must earn a doctoral degree in psychology, though they do not attend medical school. They also must complete supervised experience hours, some of which may be earned during graduate school. They also must pass an exam and stay up-to-date on continuing education.

Medical License

Psychiatrists are doctors who specialize in mental health. These providers can actively diagnose patients and prescribe medication. They must attend medical school, obtain board certification, and complete a residency. To maintain their physician credentialing, they generally need to complete 50-100 hours of continuing medical education. Continuing education hours must be earned through courses approved by the Accreditation Council for Continuing Medical Education.

Nurse Practitioner (NP) License

A nurse practitioner (NP) license is a step above an RN license. RNs who complete an eligible graduate degree and pass the nurse practitioner exam can submit an application for an NP license. 

Nurse practitioners can prescribe, dispense, and monitor medication usage for patients. The scope of their practice can vary by state, with some states allowing more independence and others requiring NPs to be supervised by a doctor (in behavioral health, this would likely be a psychiatrist). Continuing education is required for license renewal.

Licensed Professional Clinical Counselor (LPCC)

Another credential that can be used to provide counseling services is the LPCC license. Similar to other counseling licenses, an LPCC credential requires a master’s degree, supervised experience, an exam, and a criminal background check in many states.

Addiction Counseling Certification

Addiction counselors often lead group meetings for patients with addictions, such as substance use. They are not required to have a master’s degree in counseling. As such, the scope of their allowed activities is more limited than LMFT, LPCC, or LCSW licensees. 

The requirements for an addiction counseling license include graduation from an approved program (usually in the form of an associate’s degree or a certificate), supervised experience hours, and passing an exam. There are several certification levels within this field that candidates can achieve through different levels of experience or education. Specific credentials may vary by state, but continuing education is typically required to maintain all addiction counseling licenses.

How to Keep Credentials Up-to-Date for Behavioral Health Professionals

Healthcare credentialing: mother and daughter consulting a psychiatrist

One easy way to keep track of license renewals, continuing education, and provider credentialing is to use human capital management (HCM) software with credential management features. Using a unified HCM system eliminates the need for separate credentialing software and HR software. All provider information, including employment data, can be conveniently accessed on one platform.

ContinuumCloud takes it one step further with Position Control. By linking health care credentialing requirements directly to a position rather than an individual employee, organizations can automate credential expiration and renewal tracking. This is not only more efficient, but it’s also a more thorough process. 

Without this type of solution, there’s more room for error. Someone may forget to enter credential requirements during enrollment for a new employee or someone may overlook an expiration date when verifying credentials manually. 

With ContinuumCloud, companies can use Position Control to set credential requirements by position so that all employees hired for that role across the organization are automatically enrolled in credential tracking. The system will notify employees and management when credentials are approaching expiration to avoid any lapses in licensure. HR or the credentialing department can then follow up with the provider to ensure that their credential is renewed and updated in the system.

ContinuumCloud Helps You Stay Compliant With Health Care Credentialing

Maintaining up-to-date health care credentialing for all providers is imperative. Unfortunately, it can also be time-consuming. However, with the right credential management tool, it doesn’t have to be. 

ContinuumCloud’s HCM system is the only workforce management software built specifically to meet the needs of behavioral health and human services organizations. With features like Position Control, credential management can be a breeze. Contact us to learn how ContinuumCloud can optimize your credential management process.

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