One of the most common questions I get from my behavioral health clients today is:

“Are we in-network with this payer’s product line?”

That seems to be the question of the day.

Long gone are the days when a payer was just a commercial payer or a Medicaid-only payer. These days, many payer organizations offer multiple “product lines” — and unless you’re keeping track, it can be confusing and costly.

If your practice or organization isn’t careful, assigning a clinician to the wrong payer product line can lead to:

  • Denied claims

  • Lost revenue

  • Frustrated clients

  • Damaged payer relationships

Assuming you’re in-network is where financial issues often begin.

What Is a Payer Product Line?

Let’s define the term.

From a contracting perspective, payers typically break up their product offerings (often listed in separate addendums of your agreement) into three categories:

  • Commercial

  • Medicaid

  • Medicare Advantage

Each category comes with its own credentialing, billing, and administrative requirements.

Here are just a few examples:

  • A commercial product line may only allow independently licensed staff to bill for services.

  • A Medicare Advantage plan may not cover higher levels of care like Intensive Outpatient (IOP) or Residential Treatment, because traditional Medicare (CMS) doesn’t reimburse for them.

✅ Payer Product Line Checklist

Here are some tips to help your organization manage payer product lines effectively:

  1. Know what product lines are included in your agreement.

  2. Understand the sub-products under each line (e.g., Medicare Advantage, D-SNP, MyCare Ohio).

  3. Verify which clinicians are covered and credentialed under each product line — and do this regularly.

  4. Create a roster or tracking system that shows:

    • Each product line

    • The staff considered in-network for that line

  5. Always verify the client’s coverage before the first appointment.

🤝 How G&M Consulting Can Help

At G&M Consulting, we help behavioral health practices prepare for this increasing complexity. With over 43 years of experience in managed care, our team specializes in administrative strategy, payer contracting, and revenue cycle management.

If your organization needs help managing payer relationships or making sense of product lines, we’re here for you.

Let’s get you paid — correctly and on time.