Credentialing Items
You will need to have all these items prior to you can be credentialing.
1 / LLC or Sole Proprietor
A Limited Liability Company (LLC) is a business structure in the United States that combines the characteristics of a corporation with those of a partnership or sole proprietorship. An LLC provides its owners, known as members, with limited liability protection, meaning they are generally not personally responsible for the company's debts and liabilities. This structure also offers flexibility in management and tax treatment, allowing members to choose how they want the LLC to be taxed (as a sole proprietorship, partnership, S corporation, or C corporation).
2 / Tax ID Number/ Employer Identification Number
A Tax ID number, or Tax Identification Number (TIN), is a unique number assigned by the Internal Revenue Service (IRS) to individuals, businesses, and other entities for tax purposes. It is used to track tax obligations and payments. There are different types of TINs, including Social Security Numbers (SSNs), Employer Identification Numbers (EINs), and Individual Taxpayer Identification Numbers (ITINs).
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3 / National Provider Identification (NPI)
A National Provider Identifier (NPI) is a unique identification number for healthcare providers in the United States. Issued by the Centers for Medicare & Medicaid Services (CMS), it is used to identify healthcare providers in all administrative and financial transactions under the Health Insurance Portability and Accountability Act (HIPAA). The NPI ensures that providers are uniquely identified across the healthcare system, facilitating the efficient processing of claims and other transactions. ​
You will need an NPI Type I for yourself. If you have an LLC, you will need to register for an NPI Type II, as your LLC is considered a group/organization. You can find your NPI at NPPES website.
4/ Bank Letter
A bank letter is an official document issued by a bank, confirming specific information about a customer's account. It is often used for various financial and business purposes, such as verifying the existence of an account, the account holder's identity, and the account's status. Commonly, a bank letter may include details such as the account number, account balance, date of account opening, and the bank's contact information. Businesses or individuals may request a bank letter to provide proof of funds, for loan applications, or for setting up merchant accounts.​
You will need a bank letter to enroll for direct deposits with the insurances. It can take an insurance to pay by check over 45 days.
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5/ CAQH
The Council for Affordable Quality Healthcare (CAQH) is a nonprofit organization that provides solutions to improve the efficiency and quality of healthcare. One of its key initiatives is the CAQH ProView, an online database that streamlines the provider credentialing process. This database allows healthcare providers to enter and maintain their professional and practice information in a central location, which can then be accessed by health plans and other organizations for credentialing, network management, and other administrative purposes. The goal of CAQH is to reduce administrative burdens and improve the coordination of care within the healthcare system. Insurances use this database. This has to be completed prior to credentialing. You should have a leased practice location or decide to be telehealth only.
6/ Other Items We Will Need...
We will ask for your date of birth, your social security number, copies of any Board Certifications, License, DEA (only applicable to prescribing practitioners) your business W9. (Please click on W9 to get a blank copy to fill out.) When filling out the W9- line 1 is for your Business Name.) ​
Credentialing Timelines
Per State is different. Please reach out if you are wanting to know per state what the credentialing timeline looks like. Its never under 30 days... so please plan appropriately.
