If you want to start taking insurance, you might have discovered becoming an in-network provider is no cakewalk. It can be difficult to navigate the waters of insurance company jargon when you’re just starting out. It’s okay. We’re here to walk you through the process from becoming credentialed by insurance companies to becoming an in-network provider step by step.
The first thing you want to do is to make sure you meet all the qualifications that you’ll need to get credentialed. There are a few steps to getting there, but don’t worry. Take it one step at a time.
Step 1: Check in with your state’s policies. You may need to be a licensed practitioner if that is something required by your state. You can see by this list whether or not this will apply to you.
Step 2: File as an LLC or S-Corp. If you haven’t gotten this far yet, don’t sweat it. We have a walk-through for that too!
Step 3: Get Liability Insurance. This is a private practice must. There are many factors to consider when selecting an insurance provider, including amount of coverage, scope of services provided, type of coverage (e.g., in person, virtual care, or both), and more – the list goes on! Lucky for you, we have put together a long list of insurance providers that you may want to consider.
Step 4: Get your National Provider Identity (NPI). NPIs are a HIPAA protected way to identify you when filing an insurance claim. It is free to get an NPI and the application is relatively quick and easy. One of the biggest challenges seems to be finding your taxonomy number. (For Registered Dietitians, it’s 133V00000X. For Nutritionists, it’s 133N00000X.)
Now onto credentialing!
It may take awhile to get to this point, but don’t be deterred. You’re almost through. Nowadays, you don’t have to apply to every insurance company separately. It can be done with one easy and organized form through CAQH (Council for Affordable Quality Healthcare). This application is also free.
Before filling out this form, conduct a little bit of research to see what insurance companies you would like to become an in-network provider with. We recommend selecting a few – try not to put all your eggs in one basket!
The CAQH form will require your basic information. The website advises you gather all of this information together before you get started. It will ask for your basic information (name, address, contact, etc.), your education and training, specialties and board certifications, practice location information, hospital affiliation information, malpractice insurance information, work history and references, and disclosure and malpractice history. After you have filled out these forms, you will be asked which insurance companies you would like to share this information with. This is where your research comes in handy. Select the insurance companies and they will have access to your CAQH form and just like that, the credentialing process begins!
Now, just a few things to keep in mind: credentialing can take several months. It is a slow process. CAQH will contact you every 90 days to attest that the information you have provided in your form is still valid. You may want to consider following up with the insurance companies if you don’t think your form is being processed effectively.
Once you are credentialed by an insurance company, note that all companies offer different coverage. Some insurance companies will only cover a certain amount of sessions per year. It is always a good idea to familiarize yourself with what your insurance companies have agreed to cover.
In the meantime…
While you’re waiting to become an in-network provider, you may want to consider including Superbills as an alternative that could allow your clients to receive insurance reimbursements. A Superbill is essentially a receipt of the services you have provided your client. Clients can submit these to their insurance companies to (potentially) get reimbursed for your services. Alternatively, we’ve even seen some dietitians submit them on behalf of their clients! The important thing to note is that even when you submit a Superbill, you still collect payment from the client (generally before or during the time of service) and any reimbursement provided by an insurance company goes to the client directly.
By the way, it takes 90 seconds (seriously) to prepare and deliver a Superbill to your clients on Healthie. With our templates, all you need to complete are the client-specific CPT & ICD-10 codes, enter your units and fees, and our system auto-generates the rest. Plus, it’s HIPAA-compliant!