At G&M Consulting, we regularly receive questions from the behavioral health field about working with commercial insurance payers. One recent question stood out — and we felt the answer would benefit the broader provider community:

Question:

“My practice just signed a Group Agreement with a large commercial payer. How do I ‘operationalize’ that agreement so my staff understands all the clinical and administrative rules — and we get paid correctly?”

Answer:

This is an excellent and timely question.

Just because your organization signs a contract with a health plan like ABC Insurance doesn’t guarantee payment. You now need to ensure your team knows how to implement the agreement in day-to-day operations.

Here’s a step-by-step approach:

✅ Step 1: Access and Review Key Payer Resources

Before doing anything else:

  • Create an account on the payer’s provider portal
    Make sure your billing and clinical leads have access.

  • Review these essential documents:

    • Provider Manual

    • Clinical policies and documentation guidelines

    • Billing procedures and claims submission rules

    • Prior authorization protocols

✅ Step 2: Develop an Internal Operations Memo

Create a concise reference document for your staff. This memo should include:

  • Contracted Services Overview

    • What services are covered?

    • If you’re contracted for higher levels of care (like IOP), list:

      • Per diem rates

      • Unit definitions

      • Required documentation

  • Credentialed Clinicians

    • Which of your providers are listed as in-network?

  • Product Line Information

    • List the payer’s product lines (e.g., PPO, HMO, Marketplace)

    • Include sample ID cards your front desk may encounter

  • Key Contact Information

    • Phone numbers for intake, clinical authorizations, claims follow-up

  • Billing Specifics

    • Paper claims address

    • Electronic Payer ID (for clearinghouse submission)

    • Rejection/appeal steps

✅ Step 3: Assign Ongoing Monitoring Responsibilities

Choose a team member to:

  • Regularly check the payer’s portal for updates

  • Communicate any policy changes or notices to relevant staff

Remember the old carpenter’s saying:
Measure twice, cut once.
The better prepared you are up front, the fewer headaches (and denials) you’ll face later.