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One of the most frequent questions I receive from dietitians and CNSs is: Can I get credentialed in a state other than the one I live in? The short answer is YES, but as with most insurance-related matters, the details are nuanced.

Understanding the intricacies of credentialing is crucial for dietitians looking to expand their practice across state lines. Some states, such as Florida, Michigan, and New York, pose unique challenges for dietitians and CNSs trying to secure insurance contracts, particularly with providers like BCBS. In certain areas, closed insurance markets can severely limit access.

So, what can dietitians do to get credentialed in another state? Let’s dive into the legal, ethical, and practical considerations.

Is Credentialing in Another State Legal?

Generally, dietitians can contract with national insurance products like Aetna, Cigna, and UnitedHealthcare. These companies operate in every state, as does Medicare, a federal program. However, state-specific plans, like Blue Cross Blue Shield, vary. Each state has its own BCBS entity, such as Horizon BCBS in New Jersey or Highmark BCBS in Pennsylvania.

Post-pandemic, dietitians could often secure a contract in one state and bill others via telehealth as long as licensure rules were followed. However, recent changes in insurance contracts now emphasize geographical restrictions. For example, a contract originating in New Hampshire may require patients receiving services—even via telehealth—to be located within that state. These changes can necessitate additional contracts and physical office addresses in your patients’ states.

Therefore, practicing in a different state may come down to ethics.

And please don’t ask me: How do they [the insurance company] know where the patient (or you!) is located? They don’t.

But by signing your contract, you AGREE to the terms.

Also, not to pour salt on the wound, but in your documentation, you should have the location of the patient and provider in each chart note. If you are overwhelmed by what documentation for dietitians MUST entail I did an EPIC Master Class on the topic. You can check it out HERE. 

Once again, NOT all contracts have geographical restrictions as described above.

Therefore, you will want to consult with a legal expert to make sure you are following the requirement outlined in your insurance contracts.

Physical Address Requirements for Credentialing

Insurance companies require a physical address for your office in the state where you are credentialing. Virtual-only practices are not permitted. This address must often comply with ADA standards, even if it’s a residential home. Be prepared to answer questions about zoning and accessibility if you use a non-commercial property.

If you choose to use someone’s home, the insurance companies will likely ask you if the home office is ADA-compliant. How do they know it is a home and not an office building? They can often see if the address is located within a residential zone. Therefore, if you choose someone’s home as your office, you may have to answer ADA-compliant questions to the best of your ability.

Suggestions for Credentialing in Another State

If you establish a physical office in another state, you are officially conducting business there. AND I want to reiterate MANY insurance contracts prohibit THIS. Some contracts require you to be PHYSICALLY in the sate you are credentialing in. Insurance contracts often refer to this as, “Scope of Location.” This implies per your contract you are REQUIRED to located in the state your office implies while providing the service.

This comes with legal and tax obligations. Here’s a checklist of potential requirements:

• Rent office space (required for credentialing)
• Obtain an RD license (if applicable for that state)
• Secure business and county licenses
• Domesticate your business entity in the new state
• Pay state and local taxes

This list is by no means all-inclusive. And you should ALWAYS consult with a tax professional. A CPA can streamline this process, helping you navigate interstate practice’ financial and legal implications. But please know even if you CAN (no geographical restrictions in your insurance contract) practice in another state there are ADDITIONAL things you likely need to do. 

Exceptions and Ethical Considerations

If you work as a 1099 contractor for a practice in another state, these rules typically don’t apply—you’re not required to establish a physical presence. However, compliance with state laws is essential for those renting office space or setting up an address for credentialing purposes. Additionally, ensure your documentation includes the patient and provider’s location for every telehealth session. This is not just for compliance but also an ethical best practice.

Final Thoughts

Credentialing in a different state is entirely possible but requires careful planning and attention to detail. Review your contracts closely, consult with attorneys and CPAs as needed, and always adhere to state licensure and tax regulations. Dietitians can successfully expand their reach by taking these steps while maintaining compliance and ethical standards. Once again, I can’t stress this enough ALWAYS consult legal counsel when practicing across state lines.