Paid at the wrong license tier.
A credential-tier underpayment is a service by a doctoral-level or nurse practitioner clinician paid at a lower license tier's rate, usually because of an enrollment or credentialing error at the payer.
Why it happens
Many payers pay psychotherapy codes at different rates for doctoral clinicians (PhD, PsyD, MD, DO), nurse practitioners and master's-level therapists (LCSW, LPC, LMFT). If a clinician is enrolled at the wrong level, every claim they bill is paid at the lower rate until someone notices.
How Owed checks
- 01
Owed knows each clinician's license tier from your roster. For a doctoral or NP clinician's paid line, it compares the allowed amount with their own tier's contracted rate.
- 02
When the line is short by more than $1 or 1%, whichever is larger and the allowed amount matches a lower tier's rate, it's flagged. The lower rate comes from your fee schedule, or, when you haven't loaded one, from typical tier ratios (nurse practitioners at 85% and master's-level clinicians at 75% of the doctoral rate).
What you'll see
- The clinician's tier and the tier they were paid as
- The rate they should have been paid and the allowed amount
- An appeal deadline, with Tennessee's 15-month payment-correction date shown separately as an outer limit (Tenn. Code Ann. § 56-7-110(b)) on plans you've confirmed are fully insured. Pending legal review, Owed keeps the payer's applicable deadline
Rules check your remittances against the rates, settings and history available. Each finding shows its evidence; AI does not decide the result.
What to do
Check the clinician's credentialing and enrollment record with the payer and ask for the license level to be corrected, then request reprocessing of the affected claims within the corrected-claim window.
Questions
- Why is my psychologist being paid the same as a master's-level therapist?
- One possible cause is enrollment at the wrong license level. Check the clinician's enrollment and your fee schedule, then request correction and reprocessing where the contract supports a higher rate.
- Do insurers pay different rates by clinician license?
- Many do: doctoral clinicians, nurse practitioners and master's-level therapists often have separate rates for the same psychotherapy code in the same contract.
- How long do I have to dispute an underpayment in Tennessee?
- On fully insured plans, Tennessee law says an insurer isn't required to correct a payment error when the provider asks more than 15 months after receiving payment (Tenn. Code Ann. § 56-7-110(b)), and the section can't be waived by contract. Pending legal review, Owed keeps the payer's applicable deadline and shows the 15-month date separately as an outer limit.