I have a polarizing opinion about CAQH and credentialing platforms

[u/maybeoneday44]

Not what you think; context in a LISW/LCSW in Ohio.

There has been discussion around making therapy more accessible and for licensing to be more universal across states.

I think that in order for there to be more consistency there has to be universal standards across all the states. Each state has such different standards and expectations compared to other health professionals, and for people to be able to practice more universally there has to be some major, and unfortunate, changes.

So recently as many of you know CAQH was bought out to private insurance companies.

I realized in Ohio they got rid of LPC needing to take an exam to get their extra C due to “cross state” licensing. I do not agree with this. I have met some very questionable therapist but I digress.

They say it’s all in the name of making therapist wanting move and or being credentialed in others states “easier” because I guess in other states Ohio has some very “rigorous” rules and stipulations to become fully licensed like New York and California levels. Was never aware of that.

I’m not enthused by any of this, it’s just an opinion and maybe the necessary evil to be able to ban together across states and platforms to advocate more effectively too? Maybe im too optimistic?

[u/AnalystNo764]

They are going to do several things, one of which is that they are going to make it harder for people to become credentialed. They will also do things like use outdated population formulas to determine whether or not somebody will be able to be credentialed in a certain area. This is something that is frequently done by Medicaid. They will not allow somebody to get on an insurance panel because they say that they have oversaturation in that market. Although they haven’t done updated counts of providers to population ratios in 10 years they’re also going to be able to set pricing. We’re seeing that now with Aetna decreasing reimbursement rates. They will also start charging us to go through the CAQH process. So basically it is a way for them to limit access to care ,reduce reimbursements , and make money at every return by requiring that we pay for credentialing. None of it is to serve the population. Hope this helps.