How Do I Get Credentialed with Insurance Companies as a New Provider?

Here are some tips to help streamline the process. Some carriers may take up to 180 days, while others can complete credentialing within 30 days. Most new chiropractic physicians are shocked at how much time this task takes. It doesn’t matter if you have your own practice or if you are an independent contractor or associate, becoming credentialed with insurance companies is one of the hurdles to getting paid for your services.

1. Get your NPI number.

There are two types of National Provider Identifier (NPI) numbers: Individual and Organizational. When you register for an NPI number for yourself, you will need to follow it throughout your career. This number will stay with you regardless of where you work or if you incorporate your own practice or are hired somewhere else.


2. Know how you are billing for your services.

Starting the entire process over again and re-credentialing, the billing structure or tax ID can be changed if necessary. This figure is not the final figure, it will be updated after some time. If you are an independent contractor or practice as a sole proprietor, it is advisable to consult with your lawyer and/or accountant to clarify how your services will be billed. Some chiropractic physicians may choose to work under their own social security numbers. For most of the time, you will either be working for your own incorporated practice or a corporation.

3. Obtain malpractice insurance.

To ensure that your malpractice insurance coverage is adequate, make sure to have a copy of the declaration page ready for the application process. Additionally, when dealing with networks and insurance companies in different states, it is crucial to request a copy of your malpractice insurance and hold onto it. This will ensure that the listed amount in the insurance contract does not exceed or match your limits, and that you comply with the requirements set by all health insurance companies and networks.

4. Complete the CAQH application.

In order to finish the CAQH application, visit https://proview.Caqh.Org/PR/Registration. It is important to note that collecting all of the required information may take up to 2 hours, so please approach this step with seriousness. To save time, you have the option to upload your details and finalize the documentation digitally. Numerous insurance companies currently utilize a single application, known as “CAQH ProView,” to acquire your information.

5. Register with Medicare.

Unlike medical doctors, chiropractors and physicians cannot opt out of Medicare. If you intend to treat any Medicare beneficiaries, including disabled younger people and seniors, you must register as either a non-participating provider or as a participating provider with Medicare.

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

Complete your CAQH application, then reach out to each insurance company with whom you wish to participate. Prior to becoming a provider, you will have the opportunity to review the agreement and fee schedule. Before committing, ensure that you comprehend the contractual requirements and that they align with your business/practice needs. Occasionally, an insurance company might mandate that you attend to emergency patients within a specific timeframe, maintain a 24-hour answering service, or refrain from delegating certain tasks to a chiropractic assistant. Additionally, they may require you to fill out supplementary forms alongside the CAQH form. In general, accuracy and meticulousness expedite the acceptance of your application. A missed signature or incorrectly filled page can lead to significant delays.

It is important to stay abreast of changes that can happen at any moment, so once you become credentialed and start insurance billing for your services, please notify us. Members of the Illinois Chiropractic Society benefit from regular email updates, conferences, and regional seminars that keep them informed about other insurance policies and Medicare. Keeping up to date can make a big difference for your practice in the long run, as it helps you stay compliant and improves your bottom line.

Erin E. Ducat DC, CSCS, CCSP, DACRB, FACO serves as the President of the Northern District of the ICS. In Bloomingdale IL, she runs a private practice that focuses on sports medicine, non-invasive orthopedics, and rehabilitation. Erin has been a member of the Illinois Chiropractic Society (ICS) ever since her days as a chiropractic student, and she obtained her degree from the National University of Health Sciences in 2006.