To bill insurance through Headway, you must be credentialed on Headway with your client’s insurance plan (in addition to being licensed) in the state where your client is physically located during your session.
Why provider credentialing is important
Every insurance company needs to verify that the healthcare professionals in its network have the adequate education, training, and licensure to care for its members.
Because the insurance plan is agreeing to pay for a portion of their members’ care, it’s important that the plan does its due diligence to understand everything you’ve done to become the expert that you are. It also means its members — a.k.a your current and prospective clients — can trust the care they’ll get from you.
Credentialing vs. licensing
Licensing refers to the process of securing the authority to practice within a state, either through self pay or through insurance. License requirements are determined by individual states and their licensing boards (and approved/passed by their state legislature). Each license typically has certain educational, training, and continuing education requirements to obtain and renew a license. Please check with your state licensing board within each state you desire to practice for specific requirements.
Credentialing refers to the process of verifying the provider's license, education, insurance, and other information to ensure they meet the standards of practice required by an insurance company. Credentialing is required to work with an insurance plan and bill insurance.
Please note: Generally, providers must be credentialed and licensed in each state where they intend to see clients; this is true on the Headway platform as well. For example, if you are licensed and credentialed with Headway in California but only licensed (not credentialed) in New York, you can only see clients under your California license and credentialing, provided that you are credentialed with the client's specific plan in that state.
Client location
To confirm telehealth sessions, providers will be required to enter the client's location during the session. Your client must be physically located in a state where you are credentialed with their insurance plan on Headway in order to confirm the session.
We need an address on file to ensure providers are seeing their clients compliantly via telehealth, claims are routed properly, and payments are not impacted.
Managing client locations
To update your client’s virtual session location, visit your Clients list. From there, scroll down to the client, and click New location.
Alternatively, your client can add a new location directly from their account.
Billing method
Under Billing method on each client's page, we exhibit guidance for every possible state that an appointment could take place. Each practice location that a provider has on file, as well as any virtual session location that a client has, is reflected in this section.
You can refer to these guidance boxes to understand where you'll be able to see the client.
Special cases
Blue Cross and Blue Shield (BCBS) plans
Blue Cross and Blue Shield (BCBS) plans operate on a state by state basis, which means that in order to see a client, your client must be located in their plan's typical service area and you must be credentialed with their specific plan in the state (in the state where they are located).
However, the BlueCard program allows you to see clients through any BCBS plan as long as:
- Your client is located outside their plan's typical service area.
- You are licensed and credentialed with the local BCBS plan where your client is located during the session.
Example:
- Provider is credentialed with Anthem BCBS New York, and licensed in NY
- Client is located in NY for college and is insured with a BCBS NC BlueCard plan
- Provider can see this client via BlueCard, as long as they’re located in NY at the time of the appointment
Virtual networks
Opting into a virtual network allows you to see patients with BCBS plans outside of their typical service area.
For instance, if you are licensed in Texas, opting into the BCBS Massachusetts virtual network would allow you to see BCBS MA patients in Texas, even if you aren't credentialed with the local BCBS Texas plan.
Another example:
- Provider is credentialed with BCBS MA in TX via the BCBS MA virtual network.
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Provider can only see clients insured with BCBS MA that are located in TX at the time of the appointment as long as they have a TX license.
Frequently asked questions
Regardless of where your client lives, or your location during the session, you can bill sessions as long as your client is physically located (during the session) in a state where you are licensed and credentialed on Headway.
Some states have temporary practice laws to support existing provider-patient relationships. This allows a provider to practice for a limited time in another state their patient is visiting. Clinicians should consult the respective state's licensing board to confirm if this is permissible and to understand the specific conditions under which they may temporarily practice.
In emergency situations, clinicians may treat their clients on a case-by-case basis through Headway. Such sessions require comprehensive documentation detailing the crisis and its resolution and must be billed as a crisis session. In these cases, please ensure to get and document the exact address of the client at the time of the crisis session.
If this is an ongoing situation, you must get licensed and credentialed in your client’s new state to continue seeing them on Headway, or refer them to a new provider.
To continue seeing that client and billing their sessions through insurance via Headway, you must have a license and be credentialed in the new state that they are moving to.
You must be both licensed and credentialed through Headway in the state that your client is located in at the time of the session.
Please note: For insurance credentialing, participation in PSYPACT is not accepted as a license. You will need to be fully licensed to get credentialed.
You can now get credentialed in all states you’re licensed in on Headway. This allows you to continue seeing patients and to get access to accurate rates.
Verifying client location is required when submitting claims to insurance. Our insurer partners require that providers be both licensed and credentialed through Headway in the states that they see clients in. This ensures compliant billing and accurate payments. This is also an important part of client safety; in the event that a client needs immediate in-person care, it's important that you know where to send help.
Please remember, per state regulations, if you are not licensed in the state a patient is located, you cannot see that client on or off of Headway. If you need help finding your client a new provider, reach out to our support team.
As a provider, you can join sessions from any location (within the United States), as long as you’re licensed and credentialed in the state that your patient is joining the session from.
Please note: Anthem/BCBS requires providers to live in the state they'd like to be credentialed in. A provider must live in their state of residence for a minimum of 183 days to be considered a resident.
Billing locations
Billing locations indicate all the states where you can see your client based on the client’s insurance and your credentials. On each client’s page, you’ll see locations where you can see your client in person and virtually.
In-person locations are states where you have a listed office location on Headway and you’re credentialed with your client’s insurance in that state. If you see clients in person at multiple locations, please add all relevant addresses by going to Settings > Locations > Add address location in your provider portal.
Virtual locations are states where you are credentialed with your client’s insurance plan, regardless of your office locations. Your client must be located in a state where you are credentialed with their plan at the time of a virtual appointment.
Example scenario 1
In the following scenario,
- Provider is credentialed with Aetna in California and Massachusetts
- Provider’s office is in Massachusetts
- Client has Aetna
- Client’s addresses are listed in Massachusetts
What you'll see in your provider portal:
- For virtual appointments, you'll see a message that says:
We have verified that you can see your client through their insurance plan when they're at an address in California and Massachusetts. - For in-person appointments, you'll see a message that says:
We have verified that you can see your client through their insurance plan when they're at an address in Massachusetts.
Example scenario 2
In the following scenario,
- Provider is credentialed with Aetna in California and Massachusetts, and credentialed with BCBS in New York and New Jersey
- Provider’s offices are in New York and New Jersey
- Client has Aetna
- Client’s addresses are listed in California and Florida
What you'll see in your provider portal:
- For virtual appointments, you'll see a message that says:
We have verified that you can see your client through their insurance plan when they're at an address in California and Massachusetts. You won't be able to see your client through their insurance plan when they're at an address in Florida until you get credentialed with this plan in that state.
Note: In this case, while the provider has offices in NY and NJ, the provider is not credentialed with the client’s insurance (Aetna) in those states, so no in-person locations would be shown for this client until the provider got credentialed with Aetna in NY and/or NJ.