Credentialing can be a complex and overwhelming process, Let us help you!

Being credentialed with insurance companies allows you to see patients covered by specific insurance plans and bill those insurance companies directly for the services you provide. This significantly expands access to your services and can increase your patient base. 

  The popularity of insurance companies often depends on the region. Some of the largest and most recognized insurers include Blue Cross, Regence, Aetna, Cigna, Magellan, Tricare, United Healthcare, Select Health, and many others. 

   Commonly required documents include licenses, board certifications, proof of education and training, malpractice insurance, and work history.

Yes,  CAQH, which stands for the Council of Affordable and Quality Healthcare, is a nonprofit organization established several years ago by private insurance panels. Most commercial insurers require that your CAQH profile be completed before starting the credentialing process. Insurance panels use the CAQH to verify personal details, education, and work history of healthcare providers. 

Your NPI (National Provider Identifier) is a unique 10-digit number assigned to healthcare providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

The NPI-1 number specifies your license type, level, and specialty. Insurance panels require that you have your NPI-1 in place before starting the credentialing process.

   An NPI-2 is an organization identifier that reflects the location of service provision. For agency workers, it represents the employer's company name, while for private practices, it uses the business name. Businesses with a tax ID should acquire an NPI-2 to enable contracts with insurance panels at the organization level. The NPI-1 is linked to the NPI-2 for billing, ensuring payment for services. This becomes more important as your business and team grow. 

 In most cases, you cannot bill insurance for services until the credentialing process is complete.  However, some organizations offer other options while in the credentialing process. 

Delays often result from incomplete applications, missing documentation, or slow responses from primary sources 

Healthcare providers must undergo credentialing at least once every three years, though certain healthcare facilities or insurance companies may require re-credentialing more frequently.