Psychiatric Nurse Practitioners and Therapists: Are you considering using third-party platforms such as Alma, Headway, Grow Therapy, or another? Are you currently using these platforms and having issues with coordinating their use alongside your electronic medical record? This article dives into challenges, advantages, considerations, and best practices for using these platforms as part of your private practice.
The Move Into Private Practice and Where Third-Party Platforms Come Into Play
Nurse Practitioners are going into private practice at an unprecedentedly high rate. Approximately 34% of nurse practitioners are interested in or already working in their own practice (Lyons, 2024). The rate of therapists going into private practice is growing as well.
Going into private practice can be daunting considering little about it is taught in Psychiatric Mental Health Nurse Practitioner and therapist programs. There are a number of services that have marketed themselves in a way that offers help in bridging that gap. Third-party platforms such as Headway, Alma, Grow Therapy, and others advertise their ability to help providers get credentialed with insurance payers, obtain referrals, submit bills easily, and get paid consistently. I have met countless providers that have tried these platforms out and are happily building their practice. Unfortunately, coordinating the many moving parts of private practice such as billing, email, documentation, and more along with 3rd party platform use is not without its challenges.
How to Coordinate Non-Integrated Platforms Without Confusing Clients
Private practice providers who use Headway, Alma, Grow Therapy, or other similar platforms often discover the same operational headache: these platforms do not integrate with most electronic medical records, including OptiMantra. The result is duplicate work, potential client confusion, and inconsistent records. Fortunately, some of this can be mitigated by setting up a structured workflow. A streamlined process is possible, but it requires intentional system design from the moment you decide to use a 3rd party platform.
First: What Headway, Alma, Grow Therapy, and 3rd Party Platforms Actually Are
Based on how these platforms originally marketed themselves, the following should be understood:
- They are not EMRs (though they may offer their own)
- They are not insurance companies.
- They are not full service practice management platforms (though some seem to be moving towards this)
Technically, they are third party intermediary networks that function as:
- Contracted billing entities
They hold the payer contracts and submit claims under their tax ID, not yours. - Provider networks
They credential providers under their umbrella contracts and route referrals to them. - Scheduling and billing portals
They offer calendars, claims submission, payment collection, and in some cases client messaging or intake forms.- Some platforms are even moving towards having fuller-scale electronic medical records but none upon the publishing of this article fully support the work of nurse practitioners. The features offered by these platforms are conveniences, not full clinical systems.
Given the above, we recommend that documentation still belongs in your EMR for legal, regulatory, and continuity of care reasons.
An Important Side Note:
Picture this scenario: two years from now you decide to leave the platform. However, you are audited by Big Name Insurance Company. They want (and this is realistic) to audit all records for a whole group of patients from the past two years. It is possible that they may actually be auditing only clients you saw through a platform and not those you saw in your practice and billed through an individual non-platform based contract. If you are no longer with the 3rd party platform but kept all your records on their platform and not in your own electronic medical record, it may be a challenge to obtain those records. You are now at risk of the insurer performing a “claw back” and taking hard earned money from you.
The Core Problem: There Is No Integration
Headway, Alma, Grow Therapy, and other similar 3rd party platforms do not currently offer integration with Optimantra. These platforms also do not integrate with each other.
Every provider must choose a workflow that avoids:
- Duplicate charting
- Mismatched appointment times
- Inconsistent documentation
- Client confusion about portals, communication, paperwork, and billing
- Errors in prior authorizations or claims
The solution is not to abandon your EMR or the platform(s). The solution is to design a workflow that helps account for your business needs while leveraging the benefits of 3rd party platform use.
Best Practice Workflow: One EMR, One Scheduling Source, One Documentation Source
Step One: Choose your Primary System
Your primary operational system must be your EMR. For most providers reading this, that system is OptiMantra.
OptiMantra should be the only place where:
- Clinical documentation is completed unless documentation is requested by the platform (and it is permissible per your contract)
- Prescriptions and labs are ordered
- Intake forms live except the basic consents mandated by the 3rd party platform.
- Treatment plans are stored
- Messaging, chart notes, and other records are maintained
This maintains compliance, helps maintain simplicity, and avoids fragmented care.
Step Two: Use 3rd Party Platforms for What They Are Good At
Use them strictly as:
- A Partner with whom you can contract with insurance
- A billing submission entity. Use their platform to submit your bills after you see clients
- A referral source. Some providers report getting a LOT of referrals from these platforms while some may not.
- A payment processor for insurance clients’ copays, coinsurance, and healthcare costs that they may owe.
- Some providers choose not to utilize the platform’s payment processor and may use their own. However, using the platform’s processor may potentially be more cost effective. Check your contracts before choosing which is best for your practice.
What Not To Do:
- Do not use third party platforms as your clinical home.
- Do not fill in more than the minimal required fields such as session length or risk questions.
- Do not maintain records only on the platforms. These need to live in your EMR.
How to Coordinate Scheduling Without Confusing Clients
Option One: Your EMR Is the Master Calendar
This is the safest and least confusing option.
Process:
- You schedule all clients in OptiMantra.
- You manually mirror Headway or Alma clients into their respective platform calendars.
- You document only in your EMR.
- You send all clients a single onboarding message explaining that the EMR is their clinical home and the platform is how your clinic is able to offer insurance billing.
- Make sure you provide a policy that identifies how patients should contact you (through your EMR, not the 3rd party platform) and what you need from them in the 3rd party platform such as signing basic consents and uploading payment and insurance information.
My approach as a long time PMHNP Private Practice and Group Practice Owner:
- It is important to help prospective clients understand the intake process as soon as they reach out and make it as seamless as possible for them.
- Upon first contact we send a “welcome video” that goes over our process.
- You could use a video or even just a short handout that explains your intake process, expectations, what you will need, and perhaps most importantly, your use of 3rd party platforms, their role in your practice, and how the client will use (or not use) this platform in their care.
- For example, my video explains that the 3rd party platform is used only for billing and not scheduling or communication purposes and that they may need to sign forms on the platform to cover the consents for the billing that is done via this manner.
- Be ready to answer any questions or concerns and have information on the 3rd party platforms in your consent(s) as well.
- My staff have daily check sheets and protocols for orchestrating intakes as well as managing Optimantra calendars alongside third party platform calendars. They know that if a visit is scheduled in Optimantra, it needs to be added to the other platform calendar as well. They also check in regularly to see if any new referrals have come through on the 3rd party platform website. This takes just one extra minute and is very manageable if it is part of your routine and practice expectations.
Pros For This Method:
- Clients will use one portal for their care except for the initial signatures and/or uploads.
- Your documentation risk is reduced
- Your admin team has one central workflow
Cons:
- There may be some uncertainty among clients and staff. Set expectations early and communicate “what is what” in your process.
- You must manually maintain the calendars.
Should Providers Ever Do Their Own Billing Instead?
There are three reasons you might consider billing independently.
1. You want control of payer relationships
When you bill through Headway, Alma, etc. you are not in control of the contract. Your rates are set by the platform. You may be missing out on higher rates if you had individually contracted instead. You can be removed from a panel or the platform without appeal.
2. You plan to scale
Multi provider practices can quickly outgrow third party networks.
Owning your billing potentially allows:
- Better rates
- Better audit control
- Cleaner revenue reporting
- More independence in how you operate your practice and provide care
3. You want predictable revenue
Third party platforms often promise timely pay but delayed payment is a possibility as well. They can also adjust reimbursement formulas and change policies without your input. When you use third party platforms, you give up some of the control of your finances in your business. Owning your billing removes those unknowns.
However, delays and billing challenges can happen when you contract directly with insurers as well. Independent billing requires a solid understanding of billing and coding, and you may want to have a skilled biller on staff.
Many small practices choose a hybrid model: self billed plans plus 3rd party platforms for specific payers. These platforms sometimes have higher negotiated rates and therefore providers may choose to bill through the platforms to help ensure adequate reimbursement. Likewise, providers may wish to bill independently because 3rd party platforms may not contract with all plans.
The Best Overall Strategy for Most Private Practices
Use your EMR as the single source of truth
- Documentation
- Treatment plans
- Scheduling
- Clinical messaging
- Compliance records
- Order management
Framework: Set Your Business Up So that 3rd Party Platforms Are Used Only for Specific Purposes
- Insurance contracting
- Claims submission
- Payments (Insurance clients only, your cash pay clients should only be in your EMR)
- Minimal required fields. Fill in only what is necessary for billing purposes.
This works in theory but remember that you are technically a contractor for 3rd party platforms. However, this is how I and others have approached balancing third party platform use and managing our practice. We use third party platforms to become credentialed, verify benefits, submit insurance claims, and receive payment for those claims. Cash pay clients are managed fully in our EMR as well as the clients that have insurance plans that are not incorporated into the third party platform.
Other Important Considerations:
There have been some recent concerns voiced in the mental health clinic community surrounding the use of third party platforms and blurred lines regarding contract work. What I advise is that you understand your obligations to the third party platform with respect to documentation, audits, and what is truly required of contractors. If you are uncertain, refer to your contract and consider discussing it with your employment law advisor.
Additionally, some of those same voices are also expressing concern that these platforms are owned by entities that have financial interests in the insurers that they are contracted with. This may pose a significant conflict of interest. This leads to questions about security and privacy of patient information.
What you can do is ensure that your clients know that you use 3rd party platforms for billing, what the platform’s role is, and any possible alternatives. In the private practice that I scaled and sold, we utilized both 3rd party platforms and were individually contracted with insurers. This provided clients with a choice.
Protecting Your Practice While Leveraging Third-Party Platforms
For practices that want a truly all-in-one approach to billing, OptiMantra complements these platforms by providing a fully integrated EMR and practice management system. OptiMantra streamlines billing workflows, giving providers the time and clarity to focus on what matters most—providing excellent patient care while ensuring their work is accurately reimbursed.
Learn how OptiMantra can help you with a free trial or 1-on-1 demo today!
References:
Lyons, J. (2024, November 12). Findings from Nurse.org’s 2024 nurse practitioner survey. Nurse.org. https://nurse.org/education/nurse-practitioner-survey/
