What do I need for Credentialing?

If you are starting out on your own, these are a few items you will need to have ready to submit to our credentialer.
Stationery

NPI 1/ Taxonomy Code

This is your individual NPI (National Provider Identification) number. The taxonomy code is a unique 10 character code that designates your classification and specialization. You have one for yourself.

2

NPI 2/ Taxonomy Code

This is your business NPI. If you are a LLC; even as a S-Corp..you will need a NPI 2. Insurances will not use your NPI 1 for your business. Just like NPI 1, you will need to have a specific taxonomy code for your business.

3

TAX ID

This is an identification number used by the IRS. You will receive a letter (CP 575) that we will need when starting your credentialing.

4

CAQH

This is your personal profile stating all your information for the practices you work with or have worked with, education, Medicaid/Medicare IDs, references, malpractice insurance and so on. Insurances use this information to streamline their profile for you in their system. 

5

LOCATION

You must have a location already picked for your business because insurances will do a site visit to ensure the practice is actual there or receives mail there. This is important part for billing as well.

6

Copies of your license, resume and malpractice insurance.

We will need these items so verify your license type and the way your name is spelled on your license. Resume is to get your educational background. (Degree Type). Malpractice insurance, you will need to have one for yourself and one for your business. This is needed for your CAQH and also insurances may ask for this on hand as well.

7

Business Bank Account

Insurances want to make sure they send you EFT payments (direct deposits) at the beginning rather than waiting after they send you multiple checks. If you are only being credentialed under your name and NPI 1. Then you can use your own banking account. If you have an NPI 2, you will need to have a business bank account. Also have a bank letter on hand with your bank's name, address, a phone number, the routing number and your account number. Must have the bank's letterhead and a bank rep's name must be signed on the bottom of the letter.