Why Product Line Verification Matters More Than Ever One of the most common questions we hear from behavioral health organizations is: "Are we in-network with this payer's product?" It sounds like a simple question. Unfortunately, the answer isn't always simple—and assuming you know the answer can become an expensive mistake. We've worked with organizations that [...]
One of the most common mistakes organizations make is treating commercial insurance like an extension of Medicaid. It’s not. Medicaid typically offers: Broader service coverage More predictable reimbursement Minimal patient financial responsibility Commercial insurance, on the other hand: Covers a narrower set of services Varies significantly by plan and product line Shifts a large portion [...]
This question has been perplexing private practice clinicians for the last couple of years: “Why does it feel like we’re doing more work — but getting paid less from commercial insurance?” When I talk to clinicians trying to unpack this, I usually go through my punch list: Has your overall client volume changed from the [...]
There’s a difference. And in today’s healthcare environment, it matters more than ever. If your organization isn’t actively managing, strengthening, and investing in its relationships with Medicaid Managed Care Plans (MCPs), you may already be at a disadvantage. What Medicaid MCPs Really Need Medicaid MCPs, under the oversight of the Ohio Department of Medicaid, are [...]
Nothing strikes fear into the heart of an Executive Director quite like the news that a Managed Care Organization (MCO) is coming to conduct a clinical audit! It’s important to remember that MCOs have a mission: to "bend the cost curve" on behalf of their client—the Ohio Department of Medicaid. Their role is to ensure [...]
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 [...]
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 [...]
Intro: As a private practice owner or clinician, you’ve experienced tremendous change over the past few years—some of it practically overnight. As we move through 2026, it’s more important than ever to stay ahead of trends that can significantly impact your financial sustainability. Here are three key trends shaping the behavioral health landscape—and what your [...]
For most clinicians, administrative tasks are not what they went to school for! They are interested in working with their clients and their clients' families. Unfortunately, administrative tasks are a fact of life in our practices and to neglect them invites revenue disruption! Many third-party payers (both Medicaid and Commercial) have streamlined their credentialing and [...]
Should Your Community Behavioral Health Organization Contract with Commercial Insurance Payers? Traditionally, most Community Behavioral Health Organizations (CBHOs) have remained focused on Medicaid and Non-Medicaid (ADAMHS Board-funded) services — rarely venturing into the world of commercial insurance. But things are changing. With the growth of the Federal Marketplace Exchange and increasing uncertainty in Medicaid funding, [...]
