Account Matters Blog:

4 Crucial Pieces to Credentialing

Posted by Daniel Ramsey on July 12, 2018
Daniel Ramsey
Credentialing your new business can be excited but also extremely daunting for therapists who have never gone through the process before. Our company offers credentialing services to take the hassle out of the credentialing process but whether you outsource your credentialing or not there are certain things that you ABSOLUTELY need to make sure you have in place before starting the process. These documents and profiles are essential and without them, you risk delaying your approval. These crucial pieces include:

CP 575 Form- The CP 575 form is an IRS document that you receive in the mail after you’ve registered for a Tax Identification Number. This form serves as a confirmation of your Tax-ID number and many insurances request a copy. The most important part of this document is how your business name is printed by the IRS. Any application you fill out for your business needs to have the exact same spelling and punctuation as this CP 575 form because if it does not, your application may be sent back because they could not confirm the business name with the IRS. For example, if your CP 575 form says your business name is “Good Health Physical Therapy LLC” you wouldn’t want to fill out a credentialing application with “Good Health Physical Therapy, LLC.” Even though the comma seems inconsequential, insurance companies are extremely thorough and may reject the application.

CAQH Proview Profile- The CAQH Proview Profile is an essential part of the credentialing process. Insurance companies use this to verify the information you have on your insurance specific application. Providers need to update and attest to their CAQH Proview Profile information every quarter, so make sure your primary practice is accurate as well as your license information. If your CAQH is incomplete or inaccurate, your application may be delayed or rejected.  

Business License- Some states do not require PT, OT, SLP clinics to have a business license so that should be the first thing you consider when drawing up your business plan. If your state does require a business license, your desired insurances will want to have a copy for their records.

General Liability Insurance- Every provider needs to have their professional liability insurance in place, unless stated otherwise by your employer. But new businesses need to have General Liability Insurance that covers their company. Every insurance that you would ever want to be in-network with will require a copy of your liability insurance. One important thing to remember when signing up for liability insurance is to use the clinics address. Often owners will buy liability insurance before they have an established practice location and use their home address. It doesn’t always cause delays or rejections of credentialing applications, but it is always good to go back and update the address or use the practice location when applying for the liability insurance.

Credentialing requires a lot of documentation, and I mean a lot. But these are a few of the major ones that you will need established before tackling the stack of applications. If you have any credentialing horror stories, please feel free to share them with us. If you would like some advice or assistance with your credentialing, please feel free to reach out, we are more than happy to help. Just call 508-422-0231 or email daniel@dmbmcsi.com.

Topics: Credentialing

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