Telehealth practices almost always hit the same wall: the clinicians are licensed in several states, the technology works everywhere, and the payer contracts cover one state. Being licensed somewhere does not put you in network there, and a compact privilege does not either.
Our telemedicine credentialing services untangle the three separate layers, licensing, compact privileges and payer contracting, and file the enrollments in the order that actually works.
The three layers, in order
| Layer | What it gives you | What it does not |
|---|---|---|
| State license (or compact privilege) | The legal right to treat a patient physically located in that state | Any right to be paid by a plan there |
| Payer credentialing | The plan verifying your record | A contract, or a rate |
| Payer contracting | A participating provider agreement and fee schedule for that state's products | Coverage of every product the carrier sells in that state |
The rule that catches everyone: the patient's location at the time of the visit decides which state's license and which state's contract apply, not where you are sitting, and not where the patient's employer is.
The interstate compacts
Compacts speed up licensing. They do not touch payer contracting, and none of them covers every state.
- IMLC: the Interstate Medical Licensure Compact, an expedited route to full licenses in member states for physicians.
- NLC: the Nurse Licensure Compact, a multi-state license for RNs and LPNs in member states. Note it is not the same as an APRN compact.
- PSYPACT: lets participating psychologists practice telepsychology across member states.
- Counseling Compact: the equivalent for licensed professional counselors, as member states come online.
- PT Compact and ASLP-IC: for physical therapists and for audiologists and speech-language pathologists.
We check which compact your clinicians qualify for, which of your target states participate, and whether the compact route is genuinely faster than a direct license application in that state, sometimes it is not.
Payer enrollment, state by state
A national carrier is not one payer. Most operate state by state for network purposes, and each needs its own enrollment:
- Medicare is national, but you enroll against practice locations and your PECOS record must reflect where you actually practice.
- Medicaid is per state, and then per managed care plan on top of that. It is the slowest layer in any multi-state build.
- Commercial plans contract by state or by region; BCBS in particular is a federation of independent licensees, so each is a separate application.
- Behavioral carve-outs apply here too, for many plans a therapist's telehealth network is run by Optum or Evernorth, not the carrier.
We recommend sequencing: start with the two or three states holding most of your patient volume, get those live, and add states in waves rather than filing twenty applications at once and being unable to follow any of them up properly.
Telehealth billing: place of service and modifiers
Credentialing is wasted if the claims then go out wrong, so our telehealth billing services set these rules per payer at go-live. The essentials:
| Code | Meaning |
|---|---|
| POS 02 | Telehealth provided other than in the patient's home |
| POS 10 | Telehealth provided in the patient's home |
| Modifier 95 | Synchronous telemedicine service via real-time audio and video |
| Modifier 93 | Synchronous telemedicine service via audio only, where the payer recognizes it |
| Modifier GT / GQ | Still required by a few payers and by some state Medicaid programs |
Which combination a payer wants is not uniform, and getting it wrong produces a clean-looking denial that is easy to miss in bulk. We set the rules per payer at go-live.
What is included
- Licensing map: which states each clinician can reach today, and by which route.
- Compact applications where a compact is the faster path.
- CAQH ProView built and re-attested every 120 days, with every practice state listed.
- Medicare, Medicaid and commercial enrollment per state, sequenced by patient volume.
- Behavioral carve-out applications where the plan delegates its network.
- Telehealth billing set-up: POS and modifier rules per payer.
- Weekly follow-up and a written status report per state and per payer.
Related credentialing pages
- Therapists and psychologistsinsurance credentialing for therapists PSYPACT, the Counseling Compact and the behavioral carve-outs.
- NPs and PAsnurse practitioner credentialing services state practice authority varies, which matters more in a multi-state build than anywhere else.
Telehealth credentialing FAQs
Do I need to be credentialed in every state I treat patients in?
For network payment, yes. You need a license for the state the patient is in and a contract covering that state's products. A license alone lets you treat legally but does not make you payable.
Does a compact privilege mean I am credentialed?
No. A compact is a licensing mechanism. Payer credentialing and contracting are entirely separate, and they still have to be filed state by state.
Which state's rules apply, mine or the patient's?
The patient's physical location at the time of the visit. That determines the license you need, the plan whose network you must be in, and often the consent and prescribing rules as well.
How many states should we start with?
Two or three, chosen by patient volume. Twenty simultaneous applications cannot be followed up properly, and follow-up is the part that decides how long credentialing actually takes.
Is audio-only telehealth payable?
It depends on the payer, the service and the state. Where it is, it usually needs modifier 93 rather than 95. Behavioral health is the area where audio-only is most often covered.
Free credentialing check
Send us your clinician list, their licenses and your target states. We will map what each state needs, in what order, and how long it should take.
Free credentialing check Talk to a credentialing specialist