How to become a provider with insurance companies

Becoming credentialed with insurance companies is a crazy and convoluted process.  To help guide you, I am providing a basic protocol.

  1. Obtain a National Provider Identifier (NPI).  You will need this to apply for insurance reimbursement.  To get an NPI, visit the National Plan & Provider Enumeration System website.  This is probably the easiest step, so do this today.
  2. Get a CAQH ID.  Once you have an NPI you are ready to contact insurance companies.  It takes about 90 days for most companies to process your application and credential you, so the sooner you get started the better.  Fortunately, there is now one application, called CAQH (pronounced Kak-key), which all insurance companies use.  The easiest way to get the CAQH application started is to call the Provider Services for either Cigna or Aetna and ask them for a CAQH ID.  While you don’t need a CAQH ID to complete the application it seems to make things go quicker and gives that company immediate access to your application.  I called Cigna at 1-800-244-6224 and selected the options for "health care professional" and "credentialing."
  3. Complete the CAQH application by visiting the CAQH website.  This step is probably the most time consuming.  The CAQH website claims it will take two hours.  It took me four.
  4. Apply to be a provider with individual insurance companies located near you.  The information below is for providers where I live in the Northern Virginia / Maryland / Washington, DC area

 

Insurance Providers in Washington DC, VIRGINIA and MarylanD