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 the middle of 2025, 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 [...]
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 [...]
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, [...]
Are you treating your contracted Medicaid Managed Care Plans (MCPs) like customers—a relationship that must be valued, nurtured, and constantly maintained? If not, it's time to shift your mindset. Just like with any customer relationship, the key to success is understanding their needs—and then finding ways to meet them. So, the question is: What do [...]
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 [...]
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 [...]
Welcome to G&M Consulting This website is dedicated to enhancing the administrative practices of behavioral health providers. In today’s increasingly complex healthcare landscape, many clinicians find themselves overwhelmed by administrative demands—billing, authorizations, credentialing—that take precious time away from what drew them to this field in the first place: caring for clients and their families. With [...]
