How Do I Get Credentialed with Insurance Companies as a New Provider? – Illinois Chiropractic Society

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It doesn’t matter if you’re an associate, independent contractor, or have your own practice, one of the obstacles to getting paid for your services is getting accredited by insurance companies. most new chiropractic doctors are surprised by how long it takes to perform this task. some insurance companies can complete accreditation within 30 days; others may take up to 180 days. Here are some tips to help speed up the process:

1. get your npi number.

There are two types of National Provider Identification (NPI) numbers: Individual (Type 1) and Organizational (Type 2). Even before you get hired somewhere or incorporate your own practice, get your individual NPI. this number will follow you throughout your career, no matter where you work. To sign up for your individual NPI, go to https://nppes.cms.hhs.gov/#/ and follow the prompts.

Reading: How to become credentialed with insurance companies

2. know how you are billing for your services.

Most of the time, you will work for a corporation or incorporate your own practice. Some chiropractic doctors may work under their own social security numbers as sole proprietors. Make sure you know how you will be billing for your services and clarify the structure with your employer or accountant and/or attorney if you are an independent contractor or practice owner. the time to resolve this is not after accreditation. any change in the tax identification number or in the billing structure will force you to obtain the credential again and start the whole process again.

3. obtain malpractice insurance.

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All health insurance companies and networks will state that you must have malpractice insurance and request a copy of their malpractice insurance declaration page. Make sure your limits match or exceed the amount listed in the insurance network contract and have a copy of the declaration page ready for the application process.

4. complete the caqh application.

Several insurance companies now use an app, called “caqh proview”, to get your information. you can upload your information and complete paperwork online to save time. Keep in mind that it can take up to 2 hours to collect all the information requested, so don’t take this step lightly. To complete the CAQH application, go to https://proview.caqh.org/pr/registration.

5. sign up for medicare.

Unlike physicians, chiropractors cannot opt ​​out of Medicare. If you intend to treat any Medicare beneficiary, including disabled seniors and youth, you must register with Medicare as a participating or non-participating provider. The Medicare Part B insurer in Illinois is National Government Services (NGS). you can complete the online registration forms on their website. For more information on how to participate with Medicare, see this article from ICS: Medicare: Understanding the difference between opting out and opting out.

6. contact each insurance company you want to be in-network with.

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after completing your caqh application, contact each insurance company you wish to participate with. You will be able to review the contract and fee schedule before registering as a provider. Make sure you understand the requirements of the contract and that it fits the needs of your business/practice before committing to it. Sometimes an insurance company may stipulate that you see emergency patients within a specific time period, have a 24-hour answering service, or may not delegate certain services to a chiropractic assistant. In addition to the CAQH form, they may also have additional forms for you to complete. Accuracy and attention to detail generally help expedite acceptance of your application. a missing signature or an incorrectly completed page can be a major source of delay.

Once you get licensed and start billing insurance for your services, it’s important to stay on top of changes that can happen at any time. members of the illinois chiropractic society benefit from regular emails, regional seminars, and conferences that keep us informed about medicare and other insurance company policies. staying current can make a big difference in your results and also go a long way toward keeping your practice compliant in the long run.

Erin E. ducat dc, cscs, ccsp, dacrb, faco is a 2006 graduate of the national university of health sciences and has been a member of the illinois chiropractic society (ics) since he was a chiropractic student. she maintains a private practice in bloomingdale il, specializing in sports medicine, non-surgical orthopedics and rehabilitation. she is the president of the north district of the ics.

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