Headway 101
What does Headway do for providers and clients?
Headway manages credentialing, billing, and payments for providers while helping clients find and book in-network care.
What is credentialing?
The process of verifying a provider’s qualifications and eligibility with an insurance carrier so they can see clients as in-network.
What four steps must a client complete before scheduling a session?
Verify email, acknowledge Headway’s standard forms, add a valid payment method, and verify insurance details/benefits.
What’s a copay?
A flat dollar amount a client pays per session.
What are the three main plan types on Headway?
EPO, HMO, PPO.
What two documents are generated once a claim is processed?
Headway receives an ERA (Electronic Remittance Advice), and the client receives an EOB (Explanation of Benefits).
What does DPSR stand for, and why is it important?
Date Payer System Ready – it marks when the provider is fully rostered and Headway can begin submitting claims for that carrier.
What are two session types clients can schedule?
A 15-minute phone consultation (non-billable) or a full session (billable).
What’s coinsurance?
A percentage of the session fee that the client pays after meeting their deductible.
What does an EPO plan require?
Clients must use providers within a specific, narrow network for non-emergency care.
What happens 48 hours after a provider confirms a session?
Headway submits the session claim to the insurance carrier.
What is rostering?
When the carrier officially enrolls a credentialed provider in its system, marking them as in-network.
When does a client get charged and a provider payout determined?
When the provider confirms the session.
What’s a deductible?
The amount a client must pay out-of-pocket before insurance starts covering session costs.
What’s a PPO plan known for?
Flexibility — clients can see any doctor or specialist without a referral.
When are providers paid for confirmed sessions?
Sessions confirmed on the 1st–15th are paid on the last day of the month; sessions confirmed on the 16th–end of the month are paid on the 15th of the next month.
Headway credentials providers using which identifiers?
A state-specific Tax ID and the provider’s personal NPI.
How soon should a provider confirm a session after it occurs?
Ideally within 24–48 hours, but they have up to 30 days.
What’s an Out-of-Pocket Maximum (OOP Max)?
The maximum a client pays for covered services in a plan year; once met, insurance covers 100% of eligible costs.
What’s cost-sharing?
The portion of healthcare expenses the client pays (via copays, coinsurance, or deductible).
What does Headway’s EHR do for providers?
It allows providers to document sessions, track claims, and manage scheduling and billing in one place.
What happens if claims are submitted before a provider is DPSR’d?
They’re likely denied, because the provider won’t appear as in-network in the carrier’s system.
What’s the first thing you should check if multiple claims were denied even though clients were in-network?
Confirm whether the provider was DPSR’d when the claims were submitted.
What’s the difference between a deductible and an OOP Max?
The deductible is the starting point before insurance pays; the OOP Max is the cap after which insurance covers everything.
What’s the difference between individual and family plans?
Individual covers one person; family plans can include both individual and family deductibles — once the family deductible is met, coverage applies to all members.