Pre-Credentialing - Taking the First Step to Accept Insurance
Getting Started: Pre-Credentialing
Okay, so you have sat down and worked through the pros and cons of accepting health insurance in your nutrition private practice. What comes next?
There are two key steps to getting set up with insurance: credentialing and contracting. In this article, we will discuss the first action – getting set up to become credentialed.
Credentialing is the process of obtaining, verifying, and assessing the qualifications of a practitioner to ensure that you meet their internal requirements for serving as an in-network provider on their panel. Credentials are documented evidence of licensure, education, training, experience, or other qualifications. Most insurance companies credential dietitians by using the information provided in the CAQH application which we will discuss below. However, before you even attempt the application you will need to complete what I like to consider the pre-credentialing steps which I will discuss in detail here.
Step 1 in Pre-Credentialing – Get All your Acronyms in Order
To become an in-network provider, otherwise known as becoming “credentialed” with the carriers of your choice, you’ll need the following:
- an Employer Identification Number (a.k.a. EIN)
- license (* if required in your state)
- a National Provider Identifier (NPI)
- Professional liability insurance
* To see if your state requires licensure or registration click on the Academy’s handy-dandy spreadsheet on Licensure Information by State. The document also tells you what agency to follow-up with if your state does require licensure.
You can apply for your EIN and NPI using the embedded links above. Both are supplied at no cost to you. The cost of professional liability insurance varies depending on your state as well the limits you choose. As for your state license, once again that depends on the state in which you practice in. As of 2019, in CT I pay $105 per year for my license and $120 per year for my malpractice insurance.
For more information about EINs, licensure and NPIs read another one of my resource articles, “You set up your business structure – now what?”
For more information about Professional Liability Insurance click here to read “Why You Need Professional Liability Insurance ASAP” as well “Examples of Carriers who Provide Malpractice Insurance for Dietitians. (download)”
Step 2 in Pre-Credentialing – Fill out the CAQH Application
Once you have applied for and received your NPI number, your EIN, your license (if applicable) as well as your malpractice insurance – now you are ready to fill out the CAQH application.
CAQH stands for “Council for Affordable Quality Healthcare”. It is essentially an online database that stores provider information. Providers grant permission to insurance companies to review this data. This makes acquiring provider information super-duper efficient. Instead of each insurance company calling your office and requesting your work history or a copy of your license; insurance companies can go online and directly access all this information.
All the health insurance companies I am currently credential with use CAQH and require it for their enrollment process. Therefore, do not skip this step!
Here is the link for registering
How to Complete your CAQH Application
There are several steps to getting set up in CAQH which I will review. Not having a properly completed CAQH application can potentially delay your enrollment with the insurance companies. It takes LONG ENOUGH to get credentialed – don’t give anyone a reason to take even more time!
Here is the 411 on the CAQH Application and Credentialing process:
- Obtain your CAQH ID (this can take 2-3 business days – the ID will come via email)
- Set up your secure username and password
- Complete the online application and send in required documentation – this will be information like a copy of your licences, a copy of your malpractice insurance, etc.
- Send your attestation for signature which certifies the application
- Grant insurance companies access to your online application – we will talk more about this in the next step contracting.
Just a couple of quick notes about the CAQH application
- Make sure you are in the right mental state when you sit down to fill out the application. I found the process quite tedious! Plan for a couple of hours to complete the entire application. Remember – the insurance will actually read ALL the information you provide – so make sure it is accurate. Don’t rush and get sloppy!
- The application DOES NOT need to be completed in one attempt. If you find you are getting frustrated or annoyed entering in all the information. Save the information and come back at a later time. As long as you have the account set up with your username and password all the information will be stored.
- The CAQH application will require a whole bunch of information. However, before you sit down to fill it out make sure you have the following in front of you:
- Your NPI number
- Your license number (if required for your state)
- The specific dates of when/where you went to school as well as when/where you completed your dietetic internship
- The address (es) of where you intend to practice
- The carrier, policy number and effective dates of your malpractice insurance
- Your employment information with applicable dates
- At least three professional references with their title and contact information
You are now ready to start the credentialing/contracting process with the insurers.