These are the steps generally needed for a credentialer to start applying for you to become part of insurance networks.
General Steps
Step 1.
Create an NPI if you haven’t already.
You will need a physical address for this. If you are an independent practitioner without an office, you should open a PO BOX (if only doing Medicare) or rent a commercial mailbox (UPS Store for example). NPI profiles are public and having your home address listed is not ideal. This is particularly true of mental health professionals as patients can behave erratically when in crisis. If you are not working with a group, you will also need a business phone number, if you don’t want to share your home or cell phone number publicly.
Step 2.
Acquire liability insurance. All insurers require this.
Step 3.
Create a CAQH profile.
Most of what is needed to get credentialed with insurance companies will be included in your CAQH profile. Fill this out as completely as you can and upload the documents it asks for. The credentialer will need your login to CAQH to access the information within.
Step 4.
Obtain an Employer Identification Number (EIN).
This is not strictly required but is recommended. If you choose not to obtain an EIN, your Social Security Number will be listed on insurance billing documents and can be included in public databases. There are two ways to obtain one. You can request one in your own name as a sole proprietor or can incorporate a business entity such as an LLC and request an EIN for that.
Step 5.
Open a checking account for your practice.
This is also not strictly required but recommended. The IRS recommends this, it protects your personal account information, and it adheres to accounting best practices. You can use the aforementioned EIN to open a business account or use a separate retail banking account. If you plan to build your own business over the long run, a business banking account allows you to start establishing a business credit history. If you choose to create an LLC, this is required.
Additional Information and Documents Needed:
- Your SSN: some insurers require this even if you have a separate EIN. CAQH asks for this but it cannot be extracted from your profile later.
- Your EIN Tax letter: If you obtained an EIN, you will have gotten a letter telling you your EIN number. A copy of this will be needed.
- Your banking information: some insurers (like Medicare) require that you have a default bank account even if you are working with a group for billing. This includes:
- Your Routing and Account numbers
- A voided check or letter from your bank verifying the account information.
- Your CV: some insurers require a full CV. Others ask for an employment history and the CV can provide that as well.
- Your Signature: This is optional. If you provide it, the credentialer can generate documents like W-9s and EFT agreements for you. Otherwise, you will be asked to generate these when needed.