If you're considering expanding your practice or even going out on your own, there are a few common things to consider. You may ask yourself: What do I do about accepting insurance? Do I need to change anything? Where do I start?
Considering leaving a group practice?
You may be able to take your credentialing with you when switching practices. Your credentials will determine whether you will be considered in-network (INN) at your new practice.
How you are currently credentialed matters.
If you are credentialed under a group contract that is affiliated with another agency, you will likely have to start the credentialing process again for your own business. Being an existing in-network provider typically reduces your credentialing processing time.
If you are credentialed as an individual under the existing group, you will likely need to do a demographic update. Some insurance companies have a specific form they want to be completed, or they’ll want you to go on their provider portal and electronically submit this update. If an insurance company wants a demographic update via fax on your letterhead, make sure that you include all the pertinent information. It is also important to follow up with that payer to ensure your request was received and is being processed.
Most insurance companies will require new credentialing if the Employer Identification Number (EIN), also known as the Tax Identification Number (TIN), is changing. You want to give yourself plenty of time to verify your existing credentialing information and to identify the necessary steps to credential your own practice.
How do I find out how I’m currently credentialed?
One approach is to ask the person who handles credentialing at your existing organization, or alternatively, contact the insurance companies directly. You’ll want to contact the Credentialing department (sometimes also referred to as Provider Relations or Network Management) and ask for a copy of your contract. You can also ask them how to update your credentialing from group to solo. Make sure you write down the instructions and ask for a reference number for the call.
You will need an NPI-1, NPI-2 (for your own company), EIN, and a W-9. These documents are commonly requested anytime you are changing your credentialing address.
A few quick tips to keep in mind:
The average credentialing time is 60-180 days. It is imperative that you update your National Plan and Provider Enumeration System (NPPES) profile and Council for Affordable Quality Healthcare, Inc. (CAQH) profiles to add your new practice information. It is recommended that you do not remove the current employer until your new contracts are issued. Being recognized as an INN provider can decrease your credentialing timeframe with some insurance panels.
Your CAQH and NPPES profiles belong to you regardless of who created them. The CAQH ID is your professional portfolio where your credentials as a valid healthcare provider is stored. Your NPPES profile holds your National Provider Identifier (NPI) which is like your professional Social Security Number (SSN). These numbers remain the same for the duration of your career.
Lastly, make sure you are following up to check the status of your application. We recommend following up 7-10 days after you submit the application and every 20 days until you receive a response from on your application.