How to Get Credentialed
If you plan on opening an independent practice, one of the most important things on your "to-do list" if you plan on billing insurance is to get credentialed. This is a long and arduous process taking from around 60 days to several months depending on the insurance company.
The sooner you can get started, the better off you will be. I'll walk you through what you'll need to become credentialed and how to get started.
What you need:
1. A business address: As soon as you have one, start the credentialing process, even if you will not be starting your practice right away.
2. Tax ID #: These are easily obtained from your local government web site.
3. NPI #: apply online at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
4. State license, DEA number, business license
5. CLIA waived certificate: If you plan on drawing labs or doing in-office tests. For information go to: www.cms.hhs.gov/CLIA/downloads/HowObtainCertificateofWaiver.pdf
6. Professional liability insurance: Generally $1 million / $3 million is required.
7. Education history, transcripts, and professional memberships and certifications.
8. Three or four good professional reference.
9. Go online to http://www.caqh.com/ to register to be credentialed with several different companies.
10. Call the credentialing departments of the rest of the insurance companies you wish to bill and get started. You can find the numbers on each of the insurance companies web sites.
Be patient, remember the processes takes weeks to months. As soon as a company sends you an application or contract, quickly fill it out and send it back. If you don't hear from insurance companies for awhile, call the credentialing office or provider relations number and follow up.