Credentialing and Contracting: Getting Set Up to Accept Insurance

Dark-haired woman sitting at computer and smiling with a cup of coffee
Photo: UberImages/iStock/Getty Images Plus/Getty Images

You’ve decided to accept insurance in your practice — great call! You’ll be opening your doors to clients who otherwise may not have come knocking. In my first post in this series, I covered the initial steps to ensure your business is set up to accept insurance. In this post, let’s look at the two main parts to getting squared away to accept insurance: credentialing and contracting.

Get Credentialed with Insurance Companies

Credentialing is the process by which insurance companies check to make sure that “Yes, Riley is a dietitian in good standing.” This is done via the Council for Affordable Quality Healthcare. The CAQH ProView Portal securely stores your information as a healthcare provider. Once you enter your information into the portal, you can authorize specific plans to access your information for credentialing. A sampling of questions within the portal follows:

  • Basic personal information: name, address, provider type, practice setting
  • Education and training: graduate school, internships, fellowships and preceptorships
  • ID numbers: group and personal NPIs, tax ID, Medicare/Medicaid numbers
  • Specialties and certifications
  • Practice information: name, address and contact information, office manager and credentialing contact, services offered, hours of operation, partners and colleagues
  • Liability insurance information (you must have this for credentialing and contracting!)
  • Work history and references

Once you have completed the questionnaire, create a list of insurance companies you want to work with. This state-by-state guide to insurance provides a look at which companies are the players in your state. Contact each insurance company on your list and speak with a credentialing representative to get the process rolling. It’s worth noting that credentialing takes gobs of patience — this process can take upward of 20 hours to complete, over the course of many months. That’s why it is important to get started sooner rather than later, and to potentially think about hiring a firm to do this on your behalf.

Get Contracted with Insurance Companies

Contracting is the process of becoming an in-network provider with insurance companies.  This is where you get a contract that sets your reimbursement rate with each individual insurance company. It also establishes the policies for seeing and filing claims for members. It is recommended that you apply to several carriers at once, since you’ll be more likely to get through the process with at least one so that you can start seeing clients on that particular plan while you wait for the other companies to process your application.

Processing time varies depending on the insurance company; some will be fast — a month or so — and some will take several months! Again, it’s always best to start this process early so that you’re not feeling stressed if you’ve set deadlines for your business.

If you’re unsure of how to approach contracting, call the provider services contracting and credentialing contact at the carrier for your geographic area. Confirm with them that the insurance company is currently accepting new dietitians in your area. This is a good time to ask any other burning questions you may have about working with them as well.

In my next post, we’ll look at how to file claims and get reimbursed. At the end of the day, it’s nice to get paid for all of the incredible work that you do during your nutrition counseling sessions!

Krista Ulatowski on FacebookKrista Ulatowski on InstagramKrista Ulatowski on LinkedinKrista Ulatowski on Twitter
Krista Ulatowski
Krista Ulatowski, MPH, RDN, is a Seattle-based independent consultant who creates and implements marketing, communications and public relations programs for RDNs and food and beverage companies. Read her blog and connect with her on Instagram, Twitter, Facebook and LinkedIn.