Insurance credentialing
DefinitionGetting approved and contracted by a payer so you can bill in-network: verified qualifications, a signed contract and an effective date.
Credentialing covers two things payers often run together: verifying your qualifications (license, registration, NPI, liability insurance, work history) and contracting, which sets your fee schedule and your in-network effective date.
The pieces a dietitian typically needs:
- A Type 1 NPI from NPPES.
- A completed and attested CAQH ProView profile, which many commercial payers pull your data from (CAQH ProView). Keep it re-attested so a payer's file doesn't go stale.
- For Medicare, enrollment as a registered dietitian or nutrition professional (CMS: Medicare enrollment). Registered dietitians must accept assignment for MNT (CMS Claims Processing Manual, Ch. 4, §300.3).
Timelines vary by payer and by how complete your application is. The number to get in writing is the effective date: visits before it generally don't pay in-network. Ask for the fee schedule for 97802, 97803 and 97804 before you sign, and note the payer's timely filing limit while you're at it.
The whole process on two printable pages, with where each payer takes applications: the free credentialing checklist for dietitians.