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Insurance Credentialing Process for Private Practices

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If you want to start taking insurance in your nutrition practice, you might have discovered becoming an in-network provider is a process. It can be difficult to navigate the waters of insurance company jargon when you’re just starting out, but that doesn’t mean you can’t do it independently. 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 as a dietitian 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.

Steps to Take Prior to Insurance Credentialing

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.)

The Credentialing Process with Insurance Companies

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.

Tools You’ll Need to Accept Insurance

As you’re becoming credentialed with insurance companies, it’s a good thing to implement the systems that you’ll require to create a submit insurance claims. In most instances, you’ll want to use an EHR platform that also allows you to create your CMS 1500 claims. This saves time as the information from your client, business and chart notes can be pulled into your claims seamlessly.

From there, most dietitians will submit their claims through a clearinghouse, like Office Ally. A clearinghouse is the platform you use to electronically submit, and receive, claim information to/from insurance companies. Some insurance companies will allow you to submit claims directly through their own portal, but for the most part, and if you are in-network with several insurance companies, it’s beneficial to have ONE platform where you can see an overview of all claim information. Clearinghouses also automatically scroll claims searching for errors, helping to reduce the number of rejected claims you receive for technical errors.

Healthie is an all-in-one practice management platform designed for dietitians. With EHR and insurance billing features, Healthie makes it seamless to chart on clients and create CMS 1500 claims. Syncing with Office Ally, you can easily send claims to Office Ally in just one click.

Helping Clients Utilize Insurance via Superbills

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.

It takes only a few minutes 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 ensuring that your client’s private health information is always kept secure.

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