What to use instead of Headway to bill insurance
Therapists leaving Headway need to credential with insurance payers directly, set up a CAQH ProView profile, obtain their own NPI, secure malpractice insurance, and establish a clearinghouse to transmit claims electronically. Headway credentials therapists under its own payer contracts, which means leaving requires starting the credentialing process from scratch with each insurance panel.
The entire process takes 90 to 120 days for most commercial payers like Aetna, Cigna, and UnitedHealthcare. Medicare credentialing through PECOS typically takes 45 to 65 days. You should start credentialing 120 to 150 days before you plan to see your first insured patient under your own contracts.
Why therapists are leaving Headway
Headway introduced a $9.99 marketplace service fee on every appointment with clients who find the therapist through Headway's marketplace. The fee applies for as long as the therapist sees that client, not just the first session. The rollout begins in November 2026 and reaches every state by the end of 2026.
For a therapist seeing one marketplace client weekly, this adds up to roughly $400 per year in fees per client. Therapists with multiple marketplace clients face substantially higher annual costs.
The larger concern for practice owners is that both Headway and similar platforms like Alma credential therapists under the platform's payer contracts. When a therapist leaves, they lose access to those panels immediately and must re-credential independently with each insurer.
Step 1: Obtain your National Provider Identifier
Before you can credential with any payer or set up CAQH, you need an Individual NPI, also called a Type 1 NPI. If you don't already have one, register at nppes.cms.hhs.gov. The NPI is a unique 10-digit identification number required for all healthcare providers billing insurance.
The application is free and approval typically takes 7 to 10 business days. You will need your Social Security Number, practice address, and license information.
Step 2: Set up CAQH ProView
CAQH ProView is a free, shared online profile that health insurers use for provider credentialing. Instead of submitting the same documents to each payer separately, you create one CAQH profile and payers pull from it.
You will upload:
- State license (current and unrestricted)
- Individual NPI
- Malpractice insurance certificate
- Resume or CV
- Education transcripts and degree verification
- Work history for the past five years
- DEA certificate (if applicable)
CAQH requires re-attestation every 120 days, or every 180 days if you practice in Illinois. Re-attestation means logging in and confirming that all information in your profile is still current. If your profile lapses, payers see an unattested profile and will not process your application until you update and re-attest.
Document review by CAQH typically takes 2 to 3 business days. Profile activation takes 3 to 10 business days, but the full credentialing process with individual payers takes 4 to 12 weeks depending on the insurer.
Step 3: Secure malpractice insurance
Malpractice insurance is required in your CAQH profile and for every payer application. Most payers require coverage of at least $1 million per occurrence and $3 million aggregate.
You need to obtain a policy before you submit payer applications. The insurance carrier will provide a certificate of liability that you upload to CAQH.
Step 4: Submit applications to insurance payers
Once your CAQH profile is complete and attested, you can begin submitting applications to individual insurance companies. Each payer has its own application process, though most pull the majority of information directly from CAQH.
The LCSW credential is the most widely accepted across insurance panels. Every major commercial payer credentials LCSWs, including UnitedHealthcare, Anthem, Aetna, Cigna, and Humana. Medicare also credentials LCSWs directly.
Credentialing with LPC, LMFT, or LMHC credentials varies more by state and payer. Some commercial insurers credential these providers directly, while others require supervision or agency billing.
Credentialing timelines by payer
| Payer | Average Timeline | Notes | |-------|-----------------|-------| | Aetna | 60-90 days | Incomplete applications stretch beyond 120 days | | Cigna | 45-90 days | Varies based on documentation completeness | | UnitedHealthcare | 90-120 days | Longer due to multi-plan structure | | Anthem/Elevance | 90-120 days | Timeline depends on state and plan type | | Medicare (PECOS) | 45-65 days | Marriage and Family Therapists and Mental Health Counselors can enroll electronically | | Medicaid | 60 days to 6+ months | Varies significantly by state |
You must respond immediately to any requests for additional documentation. Delays in responding reset the timeline. Once approved, you will receive a participation letter with an effective date. Confirm that your name appears in the payer's online provider directory before seeing clients.
Payers require recredentialing every three years to maintain network status. This involves updating your CAQH profile and responding to any additional requests from the payer.
Step 5: Set up a clearinghouse and billing system
A medical billing clearinghouse is an intermediary service that sits between your practice management system and insurance payers. It receives claims from your system, formats them to meet each payer's specific requirements, scrubs them for errors, and transmits them securely via Electronic Data Interchange.
EHR systems generate electronic claims in ANSI X12 837 format, which is the standardized format required for insurance claims. For professional claims, providers use the 837P transaction.
The clearinghouse also delivers Electronic Remittance Advice back to your system when payers respond with payment or denial information.
Without a clearinghouse, you would need to log into each payer's separate portal, manually enter claim information, and track payments individually. For a practice billing more than a handful of claims per month, this becomes unmanageable.
How state rules affect independent credentialing
California
California does not allow LLCs for solo therapy practices. The required entity types are sole proprietorship or professional corporation. Professional corporations in California face a minimum annual tax of $800.
California Business and Professions Code Section 650(a) prohibits fee-splitting. The law states that any rebate, refund, commission, or other consideration as compensation for referring patients is unlawful. Penalties include up to $50,000 per violation, county jail up to one year, and potential state prison time. The violation is classified as a wobbler, meaning it can be charged as either a misdemeanor or felony.
Texas
Texas allows LPC-Associates and LMFT-Associates to own and operate private practices while under supervision, but an LMSW who intends to apply for LCSW may not own or operate a private clinical practice. Therapists must complete their 3,000 required supervised clinical hours and upgrade to a fully independent license before forming a solo PLLC and billing commercial insurance independently.
Texas Civil Practice and Remedies Code Sections 146.002 and 146.003 require providers to bill patients not later than the first day of the 11th month after the date the services are provided. Missing this deadline means the provider cannot collect from the patient or family.
New York
New York Education Law Section 6509-a prohibits licensed professionals from splitting fees with another person or entity for the referral of a patient or client. The law applies to all professions licensed by the New York State Education Department, including therapists. A violation constitutes professional misconduct and can result in license suspension or revocation.
LMHCs gained Medicaid billing privileges in New York effective July 1, 2022 and face specific restrictions on practice settings and supervision requirements.
Florida
Florida licensed mental health counselors and marriage and family therapists can bill Medicaid directly in most managed care organizations.
Medicaid differences by state
Medicaid billing rules for therapists vary significantly by state:
- California: LMFTs, LCSWs, and LPCCs can bill directly under certain programs. Others require supervision or agency billing.
- Texas: LPCs and LMFTs often must bill through a licensed clinic rather than independently.
- New York: LMHCs gained Medicaid billing privileges recently and face specific practice restrictions.
- Florida: LMHCs and LMFTs can bill directly in most managed care organizations.
Credentialing wait times for commercial payers do not differ significantly by state. The same 90-120 day timeline applies nationally for Aetna, Cigna, UnitedHealthcare, and other major carriers. Medicaid timelines vary from 60 days to six months or more depending on the state.
What therapists commonly get wrong
Starting credentialing too late
The most expensive mistake is starting credentialing after you need to begin seeing insured patients. If you wait until you leave Headway to begin the process, you face 90 to 120 days without the ability to bill insurance under your own contracts.
Start credentialing 120 to 150 days before your planned first patient day under your own panels. Beginning earlier rarely hurts. Beginning late almost always costs billable weeks.
Letting CAQH attestation lapse
If your CAQH profile is out of date, every payer that reads it sees an unattested profile and the application stops. You must log in, update any changed information, and re-attest before the payer will continue processing.
Work history gaps, outdated malpractice information, or a lapsed attestation are the most common causes of application delays. Set a calendar reminder for every 110 days to re-attest before the 120-day deadline.
Confusing credentialing approval with billing activation
Receiving an approval letter from a payer does not mean you are ready to bill. You also need to:
- Confirm your name appears in the payer's provider directory
- Verify that the correct NPI, tax ID, and address are on file
- Test a claim submission through your clearinghouse
- Confirm that your clearinghouse has a trading partner agreement with that payer
The practical timeline is not application-to-approval. It is provider-ready-to-bill-cleanly. Track both milestones separately.
Failing to check license portability for telehealth
If you see clients via telehealth, you must hold an active license in the state where the client is physically located during the session. California, Texas, New York, and Florida all require this. Some states offer temporary or reciprocal licenses, but most require a full application and credentialing process in each state.
Do not assume that credentialing with a national payer like UnitedHealthcare or Aetna grants you the ability to see clients in all states. You must be licensed and credentialed in each state separately.
What independent billing actually costs
Leaving Headway eliminates the $9.99 per-session marketplace fee, but it does not eliminate billing costs entirely.
You will need:
- Malpractice insurance: Typically required at $1 million per occurrence and $3 million aggregate
- Clearinghouse fees: Some clearinghouses charge per claim, others charge a monthly fee, and some EHR systems include clearinghouse access
- Practice management or EHR software: Required to generate claims in the correct 837P format and track payments
- Time for claim management: Even with a clearinghouse, you will spend time responding to denials, verifying eligibility, and tracking unpaid claims
The financial breakeven depends on how many of your current clients came through Headway's marketplace versus your own referrals. If most of your clients are marketplace referrals, the $9.99 fee applies to most of your caseload. If most found you independently, the fee affects fewer sessions.
Federal rules that apply everywhere
Medicare enrollment for Marriage and Family Therapists and Mental Health Counselors uses the Provider Enrollment, Chain, and Ownership System. The CMS-855I application is completed by physicians and non-physician practitioners who render Medicare Part B services.
The ANSI X12 837P transaction standard for professional claims is federally mandated and applies nationwide. All clearinghouses and payers must accept this format.
CAQH ProView re-attestation timelines are set by CAQH and apply uniformly across all states except Illinois, which has a 180-day cycle instead of 120 days.
Next steps after credentialing
Once you are credentialed and have submitted your first claims, expect your first payments 30 to 45 days after the claim submission date for clean claims. Denied or rejected claims take longer and require resubmission.
Set up a system to track:
- Claim submission dates
- Expected payment dates (typically 30 days after submission)
- Denials and the reason codes
- Client balances after insurance payment
Most payers send Electronic Remittance Advice through your clearinghouse. This document shows what the payer paid, what they denied, and what the patient owes. Your practice management system should import this automatically and post payments to the correct client accounts.
Verify insurance eligibility before every session, or at least monthly for ongoing clients. Eligibility can change if a client changes jobs, loses coverage, or switches plans. Your clearinghouse should offer real-time or batch eligibility checks.
When to credential and when to stay on a platform
Credentialing independently makes sense if:
- Most of your clients came from your own referral sources, not Headway's marketplace
- You plan to grow your practice beyond a solo caseload
- You want full control over your billing and client relationships
- You are licensed in one state and see most clients in that state
- You have the time and systems to manage credentialing, billing, and denials
Staying on Headway or a similar platform may make sense if:
- Most of your clients come from the platform's marketplace
- You are early in building your practice and need the client flow
- You do not want to manage insurance billing yourself
- You see clients in multiple states and want to avoid credentialing in each one separately
- The $9.99 per-session fee is less than the cost of your time managing billing
There is no universal right answer. The calculation depends on your current caseload, referral sources, growth plans, and tolerance for administrative work.
AgenciesForge runs credentialing, charting, scheduling, and billing on one system with the clearinghouse included and no per-seat fees.