The RDtoCEO Podcast
Dive into The RDtoCEO Podcast, hosted by Registered Dietitian and CEO, Eva Haldis, where she shares her journey in entrepreneurship, with discussions on the basics on building a private practice and becoming a confident CEO. The RDtoCEO Podcast is your go-to resource for mastering the art of transitioning from a dietitian to a successful CEO.
The RDtoCEO Podcast
The 411 on Credentialing with Insurance
Is accepting insurance the right move for your dietitian practice? Tune into this episode of the RDtoCEO podcast to uncover the truth behind credentialing with insurance and what it means for your business. We break down the factors that can impact your decision, such as your business model, location, and clientele, providing you with a clear roadmap for getting started. You'll gain insights into the steps required to get credentialed so you can get started TODAY!
Want a question answered on the podcast? Send me a voice message, or a text message, and maybe it'll be featured and discussed on the next episode! Interested?
You can send me a message on IG - https://www.instagram.com/evahaldis_rd/
or send me a VM (voice message) or text - (857) VMRDCEO aka (857) 867-3236
Insurance Credentialing Links Mentioned:
NPI Registry Website: National Plan and Provider Enumeration System (NPPES) - https://npiregistry.cms.hhs.gov/
CAQH Website: CAQH ProView - https://proview.caqh.org/
IRS Website for Blank W-9 Form: IRS W-9 Form - https://www.irs.gov/pub/irs-pdf/fw9.pdf
Facebook Group - Insurance Credentialing and Billing for Dietitian Nutritionists
Want a question answered on the podcast? Send me a message, or a text message, and maybe it'll be featured in an episode!
You can send me a message on IG -
https://www.instagram.com/evahaldis_rd or https://www.instagram.com/rdtoceo
Find more about RDtoCEO at https://www.rdtoceo.com
For episode updates and coaching packages, check out our website - www.rdtoceo.com
Affiliate Links Often Mentioned:
Gusto for Payroll - https://gusto.com/h/eva6486
Practice Better- https://practicebetter.partnerlinks.io/evahaldis9298
*Please note that while we strive to provide valuable insights, our podcast is not a replacement for personalized legal or financial counsel. We strongly advise consulting with qualified professionals for specific advice tailored to your individual circumstances.*
Welcome to the RD to CEO podcast. I'm your host, eva Haldis, registered dietitian, who one day found herself a whole CEO of a business. Join me as we navigate the world of entrepreneurship so you can go from being an RD who sees clients in private practice to a confident CEO growing the practice of your dreams. Hi everyone, Welcome back to another episode of the RD to CEO podcast. Today's episode is going to be all on the 411, on credentialing with insurance. We'll talk a little bit about should you get credentialed with insurance and accept insurance and what are the considerations you might want to take when making that decision, and I'm also going to go over sort of the intro steps to getting credentialed and what you'll need to have set up before you do so. This should be a quick episode on just some basic information when it comes to the starting process of taking insurance and credentialing is really that first step, obviously, because you have to be credentialed to be in network and to be able to bill. In this episode I do talk a little bit about the new Practice Better Integration, claimmd and when I recorded this episode we were still using Office Ally and if you're still new to the insurance world, you might be like Eva what are you talking about. You'll understand a little bit more once you get into the episode what I'm talking about. But both of those things are what's called a clearinghouse, which I'll also explain in the episode. But I did want to just say, since I'm doing this intro a little bit, after recording the actual episode, we did actually switch over to Practice Better's new integration ClaimMD for billing insurance directly in Practice Better and honestly, it's going really really well. So I just wanted to add that little tidbit, because I'm not really going to speak too much on it in this episode, but thought I'd mention that.
Speaker 1:The other thing I want to say before we get into the episode is I would really love to incorporate listener questions into the episode. So what my hope is is you know, depending on how many questions I get, of course, whether I'll do one or two per episode, and my hope is that I'll be able to answer one or two questions towards the end of the episodes. I thought that'd be a really cool way to get some interaction with folks that are listening. Obviously, this is still a pretty new podcast, but if you are listening and there's something that either you think would be a really interesting topic or if you honestly have a very specific question of like. Here's where I'm at in my practice and here's the question I have. I would love to be able to answer that on the podcast.
Speaker 1:So how I'm going to do that is one of two ways. You can message me on my Instagram. So if you're not following my professional account it is at evahaldus, underscore rd I will of course link it in the show notes. So if you do follow me or are going to rd, I will of course link it in the show notes. So if you do follow me or are going to start following me, you can of course message me on there. I'd really love to use voice messages so that I can actually play the message and the question and you can sort of explain yourself. If it's like a more specific question, if it's more like a general question or maybe some advice, questions on business decisions, so I'd love a voice message. Or if you'd rather do just like a message, you can message me on Instagram. The other option is and honestly this took me like 15 minutes to figure out and find a phone number that I could use, but I did create a new phone number that you can use to message me once again via text message or send me a voice message, and that number will be 857-VMRDCEO. Again, the number is 857-VMRDCEO and those numbers are 857-867-3236. So if you feel so inclined and would love to have a question answered or get some advice on something business related, please message me one way of those two options that I listed. Both info will be linked in the show notes, of course, so hopefully we'll get some questions and start rolling out some of those in the next few episodes.
Speaker 1:All right, so without further ado, let's get into the episode today on credentialing with insurance. Okay, so I think it's important to start the conversation on should you be accepting insurance as a dietitian in private practice? That's a very personal decision to make and it really is going to involve the business structure you want to have, where you live and where you'll see clients. I'll say where you live, slash, where your clients will be and what kind of work you do, and also really what business model you want to adapt or adopt into your practice. Maybe adopt is the right word versus adapt, but either way, you really want to think about.
Speaker 1:Okay, what am I hoping to do with my private practice? I think this is where the RD to CEO podcast is really hoping to highlight is not the kind of, like you know, exciting, sparkly things we see on Instagram where you're selling packages and making all this money and charging thousands of dollars. Listen, all power to dietitians who are out there making the big money doing that. I really want to talk to the people that are growing that brick and mortar or local private practice maybe not even brick and mortar, but maybe virtual, but really just hoping to meet clients one-on-one, do very specific work and are doing work that's going to be more centered in that way and not maybe driven by making these decisions that are going to be these big ticket items. Not to say that there's not services out there that can do that. That's just not what model I know personally as a dietitian and the one that I wanted to build.
Speaker 1:It was really important for me in the work that I was doing to really be aligned with the value of being accessible, and while I started out as a private pay dietitian and I was able to have clients who paid out of pocket, I knew that if I was going to grow my practice, I really wanted to be more accessible to folks and truthfully, if I'm being honest, it's not just about that. I thought, okay, if I'm credentialed, then I'll be able to have more clients because the marketing will just be done for me. And I think that's something that's like a misconception, is like, once you're in network, that the clients will just flow in. Maybe some for some people. That is true depending on where you live.
Speaker 1:If there's not a lot of dietitians in network, you know, depending on the work you do. For me, because our practice is a specialty practice that works primarily with eating disorders being listed in insurance websites, you know, provider list isn't always actually the most helpful for us because a lot of times people that find us through there are not maybe looking for the services that we provide more specifically. But I think for people that maybe are doing more general nutrition or, you know, things like diabetes or other medical nutrition kind of topics where providers like doctors are often referring, having that insurance credentialing connection and also being listed on the websites can be a really good marketing tool. But I don't think it can be like the only one and I don't think people should expect like, once you're a network, you're just gonna have clients like running and flowing through the door. That certainly wasn't the case for me and it's certainly not the case for a lot of people that I speak with. So that's just something to keep in mind.
Speaker 1:But for me it was a decision that I made, one around that value, around being accessible. But also my hope was that being in network was going to allow for more clients to come through the door. I will say that wasn't the thing that ultimately allowed for us to get more referrals. My practice, more specifically, I would say most of our referrals are coming from other providers. That's really the marketing that I've spent a lot of time doing. But there are other opportunities out there, I think, for insurance providers to be able to sort of reach more people more. So, like outside of doing the networking with providers, it really sort of just depends on your specialty. So I think when you're coming to the decision of like do I really should I take it right, it's going to depend on where you live and what state you're in and where the clients that you're going to be seeing are living.
Speaker 1:Some states do not even accept dietitians to be credentialed with insurance companies. We are in Pennsylvania, but we can bill other plans in other states or if a client maybe lives in Pennsylvania, but their business that they work for and the insurance they get is from a different state. There have been a couple of states that we have been unable to bill insurance. I'll have to double check, but I think one of them was like a Blue Cross plan, michigan. I want to say I believe they just don't allow for dietitians to be credentialed and they won't allow dietitians to bill for nutrition services. They have coverage for nutrition services if it was from a doctor, but dietitians are not allowed to bill for that, which is a whole other episode for a whole other day. So it really sort of depends on where you live, because for me here in Pennsylvania we can bill for insurance.
Speaker 1:There's a lot of insurance companies. They have really good coverage, I would say, decent reimbursements, and so it makes sense for people in Pennsylvania to be able to do that. That's not the case for every state, so I don't want people listening being like, well, I want to be accessible, but I live in a state where it's out of my hands, right. So that's going to make a big determination whether or not you do accept insurance. Some states reimbursement really sucks and it's not something that's like a livable wage and it's nothing that's like sustainable for a practice to do, to take insurance Because, at the end of the day, like you still have to sustain yourself and like, yes, we live in a capitalistic world, but like you still need to take care of your basic needs and maybe you have things you want right, Like we also need to have money to do the things we want to do. And so some insurance companies maybe their reimbursement's really low or they don't cover a lot of sessions and that's like the main plan in your state it wouldn't really maybe make sense then to take insurance if that was the case.
Speaker 1:But I think, if you live in a bigger state that maybe one does allow for dietitians to be credentialed and also has good reimbursement, it would make sense that that could be a good idea. How would you even know to find out? And maybe the other question that is like okay, well, how do I know if my state has good reimbursement or what insurance plans to take? This is really where you want to start maybe either reaching out to some local RDs, looking on their websites, joining local Facebook groups I'm in a lot of different Facebook groups for dietitians. That's like one of the main reasons I keep Facebook honestly, is because there's a lot of great information in those Facebook groups, especially the insurance credentialing group which I'll link in the show notes. So when you're trying to figure out, okay, which insurance company should I get credentialed with or what's the reimbursement, I think technically we're not allowed to share specifics around how much the insurance company reimburses you, but people can generalize and give you kind of a good sense of like. Generally, on average, this is how much you're getting you know, without saying exactly what the amount that you're getting.
Speaker 1:But it's helpful to see what other maybe dietitians in your area, what insurances they accept and if you're finding trends, that's probably a good indicator that that's the main plans in your area or that have good coverage. You know, if you have a local Facebook group for dietitians, so like we have one that's like PA dietitians or dietitians in private practice in PA I forget what it's called so in there, that would be a good place if I was just starting out to say, hey, what insurance you know, what insurance companies do you all accept? What's the better plans to take, those are great places just to get some more preliminary information, some more preliminary information, and so if you are kind of in that boat of like, okay, I'm starting my private practice, or maybe I'm already in private practice, but I want to take insurance. I figured out okay, this is the state that I live in, these are the insurance plans that tend to have great coverage and good reimbursement and I want to go ahead and start the process. That's where the next part is okay.
Speaker 1:So now, what? How do I get to that place? Right? So what do I have to do first in order to get credentialed with insurance? So the main things we'll talk about in this portion of the episode is going to be on the logistical stuff of what you need to sort of have in place and set up and how to do it. So the very first thing you'll have to do, if you don't already have one, is get an NPI number. So the NPI stands for National Provider Identifier. This is the number that you will be associated with in the credentialing or in the insurance company's listing. They'll give your NPI and that's going to be what's going to be associated with you as a provider. So number one the first thing you want to do is go to the mpiregistrycmshhsgov website and register on there. It's very simple and you can get it right away.
Speaker 1:One of the things I see often is should I get an MPI-1 or an MPI-2? So the MPI-1 is an individual MPI number, so that is for you as the individual provider. The MPI-2 tends to be for a group, so that is like your practice. People sometimes will say do I need to do both? Do I need to do one? And honestly, you know, when I first started my practice I did not ever think that I was going to start a group practice and grow my team, so I probably wasn't thinking that far ahead.
Speaker 1:But if you maybe sort of know that there's a possibility that you might want to hire one day or offer, you know, have other support on your team, it wouldn't hurt to start off with an MPI-2. Basically it'll sort of act as like an umbrella of like you know, our MPI-2 is with my practice and then each of the clinicians on my team. We all have our own individual MPI, so it sort of allows when we're billing insurance, one of my clinicians is the actual provider but it's being billed as the team MPI-2 number, so it's going to be the checks. Everything is coming to the practice, and so that's really sort of the difference between the MPI-1 is you as the individual. Mpi-2 is going to be more of that like group MPI number, so you could do both. You could start out with one and then down the road you decide. You know what I do want to hire. It's not something that you can't do after the fact, and so it's just kind of a matter of deciding early on if you want to do that now or just wait and see. So, on the MPI registry website, which I will link in the show notes, it's very simple. Just fill out some information and you get it pretty immediately. They'll email you your MPI number. Once you have that great, exciting Next thing you want to do is you're going to fill out a CAQH form, so CAQH provider data portal.
Speaker 1:Caqh is a website that basically is kind of like the central hub that insurance companies are going to pull your information from. So in there is where your updated office information, where your updated licensing information will be. If you have liability insurance, which you will need in order to be credentialed as an insurance provider, caqh will hold all that information. So when you credential and fill out an application for, let's say, independence, blue Cross Insurance, they'll ask you for sort of the basics your name, your NPI number, date of birth, some address, phone number, and then CAQH is where they're going to go to pull the information around you know, education, background, if you have certain specialties.
Speaker 1:The CQH portal itself is not just for dietitians, so you'll see questions in that form. That's like what does this mean? A lot of those questions are also just for you know, providers who are like other practitioners, such as doctors, nursing. I mean, every medical provider has an MPI and CAQH account if they're going to be in network with insurance. So that's why there's going to be some questions in there that really aren't relevant for us as dieticians.
Speaker 1:But you'll go into CAQH once you have your MPI number and then you're going to get a CAQH identifying number. They'll email that to you and then you're going to go through the actual CAQH application, which is very extensive. It's just a lot of background questions like your practicing location, your address, education, background, your license. They'll ask you for your license number, your CDR information. It'll go through a lot of those things Ask about, like you know, are you accepting new patient? Are you only virtual, like? There's just a lot of information that goes into CQH. It will ask for your liability insurance information and you will have to show proof of that through your liability insurance company. They'll send you a sheet that you can upload into CQH, and so that's going to be that central location that insurance companies will then pull your information from as you're credentialing. So that'll be pretty much.
Speaker 1:The second step that you'll wanna take is to fill out that CAQH portal. Once that's done, that's when you can start actually applying for insurance companies. So if you've identified which insurance companies you wanna get credentialed with, you'll want to go to the website. Honestly, a lot of times I just Google like I think that's how I did it for the newer plans that we got to network with last year, like United Credentialing, and see what comes up. You can always ask in the Facebook groups. You know, like I said, are great resources. Amy Plano has a lot of great resources on insurance credentialing, so there's a lot of places out there that you can find this information. A lot of times you'll just, honestly, go to their website and look for something that says provider, provider tools, provider management, and in there there'll be a credentialing page somewhere.
Speaker 1:When you're filling out the application, there's going to be options like medical, behavioral, like which one am I? We, as dietitians, are going to be billed under the medical group, so you'll want to pick the medical forms to fill out, and that's what you'll need. Some insurance companies require a W-9 form to also be uploaded when you're submitting the application for insurance. Once again, go to Google W-9 and you'll see. The first thing that comes up is form W-9 from the IRS website. That's the one that you'll want. It's a blank W-9 form and basically what it's used for is it's going to just allow the insurance company sort of verify your information your tax ID number, who's receiving the income?
Speaker 1:As the practice, this is where that MPI-1, mpi-2 thing comes into play. So, for example, when we credentialed new clinicians on our team, their W-9 will be filled out as if it's for them and they give you the option of a tax ID number or a social security number. The clinicians put their social information in there, but once again, they're being credentialed under the group, so the group W-9, which the credentialing has already been completed for. They know that that's where the income is going. It's kind of like when you start taking insurance, it's almost like you're a contractor with the insurance companies, and so it's sort of how they're going to keep track of who they're paying and how much income is being generated by that person.
Speaker 1:Don't quote me on all that you know, talk to your account, but anyways, that's my understanding of what a W-9 form is, and so, for example, I know for us at NAH and United, I believe, have a W-9 form that needs to be filled out. So that's one of those things you might want to just have ready and available and filled outside when you're doing those applications. What the process will be, it'll say these are the things you'll need to have CQH tax ID number, which, if you listened to one of my earlier episodes, I talked about getting a tax ID number, but they'll tell you if they need a W-9 form uploaded with the application process. I recommend keeping track of everything. So create a spreadsheet I actually have a spreadsheet and maybe I'll eventually just create a template that I can put on my website that people can download for it but really keeping track of, like, what website you went to to fill this out, when did you fill it out? Did they give you a reference number? I recommend keeping it in one place. So like create a Google sheet, put the name of the insurance company, put the name of? You know, put the website, the process. Did you need to do anything additional to the normal website application? When was it submitted? Did you get a you know a reference number, because you'll want that information if you need it and it's sometimes so hard, you know. I know I probably wrote a million things down on Post-it notes early on, but eventually I started keeping track of everything and it became much easier and much more helpful, as I need to do it more and more, especially if you plan to grow your team. So those are the main steps getting that PI number, filling out your CQH, figure out which insurance companies you want to be credentialed with and actually applying.
Speaker 1:The next step that most people want to know is how long does it take? It really depends, you know, once again, on the state you live in, which insurance company and probably time of year. I would say it can take anywhere from like three to six months, sometimes, I think, early on. I mean, we applied for an insurance company called UPMC, I want to say, like a year ago and we heard from them in October that it was approved and haven't heard since. So that's been a really long one. That is not the typical. I don't want to scare you away, that is not typical. The other ones tend to take a little bit less time, somewhere up to like three months.
Speaker 1:The thing that really sucks is if you put something incorrect. Or I remember we had an application once that we were filling out when we were still doing things mostly virtually. We did have an office space for in-office options. But they asked is this a virtual only provider? And I think I put yes, because at the time that's what we were doing, and they were like we are not accepting people that are only doing virtual and this has been closed, and we had to resubmit the application, like they couldn't just reopen it when I said, okay, well, we have an office, we can do a hybrid. So we had to like restart the whole process. Or if you enter in something incorrectly, it starts a process over again and they add another 30 business days of the process. So it really can take a little bit of time If you're someone that is going to be interested in doing a group practice and like how to credential those folks you know I always tell new applicants or new employees that are coming on the process itself takes like three months minimum I pretty much.
Speaker 1:Once somebody says they accept, once we send them that offer letter, I'm trying to get the ball rolling as quickly as we can. On the credentialing process, I would love to like. I usually takes me about like a week or two after that to start the process, sometimes like I wish I could do it even sooner, but it just takes time, unfortunately, and that's just something. That's something to prepare for. It's nice though, because I think once we started the process with clients, I was like listen, I'm not in network yet, I will be in a few months or with new clinicians. You know we will tell people like they're currently not in network but they will be. You know your insurance will only cover six sessions anyway, so you might as well maybe start now, especially for us. We work with the insurers. They're a little bit more long-term. You know your insurance will eventually cover it. In the meantime they can always submit for out-of-network reimbursement if they need to. So it does take some time, but after that you should be pretty smooth sailing, so anticipate that. That is one of the other challenges, of course, of accepting insurance.
Speaker 1:Lastly, I know I said I wasn't going to talk about specifics on billing because I think that's just going to be a whole other episode topic of knowing how to do it. But this is really where deciding what EMR you're going to use is going to come into play, or what you have access to and where to build certain plans. So we use Practice Better, and Practice Better just recently added an integration to be able to bill insurance directly through there. But basically there's something called a clearinghouse and that's where insurance claims go to to become processed. There's a few different ones out there and a lot of the insurance companies have other kind of websites and things that they use to where you can look up claim information and also where you can submit claims possibly, and there's also more centralized clearinghouses. So for us, because we use Practice Better and they only recently added something that you could bill directly in there, we've always used Office Ally as our clearinghouse. So we have to create something called a CMS 1500 form, which is really what pulls all the information from the client session, and then that form is submitted to Office Ally and that's how they'll get that information to bill the insurance. If you use Practice Better, now you can do that. You can also try to do integration with ClaimMD. I've heard really great things about it. Simple Practice has a built-in clearinghouse, so what that means is in Simple Practice it's a little bit of a quicker option than in Practice Better. You can bill pretty quickly and then you'll actually receive updates about your insurance claims directly in your Simple Practice, whereas for us with Practice Better we get that information through Office Ally and then we update that in Practice Better. With the new integration of ClaimMD that's going to be that more integrated in-house clearinghouse and so it should be updating folks in Practice Better that use ClaimMD.
Speaker 1:I know Healthy has a integration with Office Ally but you still have to create the same CMS forms. But you can do that. You can submit them. I believe in Healthy. I don't know about Calix, I forget what they do as far as insurance billing, but your EMR will determine how you're going to submit for insurance claims.
Speaker 1:The different insurance companies also have different websites. The main big ones that you're going to want to know about Avality. That one is typically Aetna plans and Highmark plans just also started using Avality. So in Avality you'll want to get a login for that if you're going to be taking either of those two plans in particular, and in Avality what you'll be able to do is look up claim information. You'll be able to look up clients' benefits in there. You won't be able to look up if they have insurance or if they have benefits for nutrition visits. Unfortunately that's really not built into most or like really any of the insurance websites. Unfortunately People do have to call and verify. But you can at least see like their information and is it active, and then you can also look up the claim information. I believe you can also submit claims in availability for NN Highmark.
Speaker 1:Once again, we use Office Ally, but I think you can do that. Independence Blue Cross plans in Pennsylvania in particular we use something called the Pair Portal. That's Independence Blue Cross's central system. That's where we can look up claim information in there for the Independence Blue Cross and Independence Administrator plans. So that's Pair Portal.
Speaker 1:Navinet was also a really big one. They used to have high marks information there. Now they've switched. I believe in Navinet you can actually get access to all the different payers, but that costs money. I don't pay for Navinet. I don't pay for Avality. Those are all free systems or the Pair Portal, but we do pay for Office Ally. So there's ways to sort of go around it. But I would say like the easiest option for us is Office Ally because we can just once all the claims are done, they kind of you can download them all at once and then it's submitted. I think if you were to use the other options you'd have to do things much more manually and slower if your EMR does not have an integration for that billing. So it'll sort of depend on how you bill as well and what you have access to. So that was probably a lot of information and I hope it was helpful to kind of break it down of like the step-by-step process of getting that process started.
Speaker 1:In a future episode, like I said, I do want to talk a lot more about actually billing, the terminology around billing, like what is an ELB, what is the difference between a co-insurance and a deductible or a copay, what do I need to know, how do I set my rates, all those kinds of questions around the specifics when it comes to actual billing. So that is a future episode that is coming down the road. If you have any questions about that particular or other insurance questions, I'm going to link my contact page on the show notes If you go in there and you want to ask a question for the podcast, please do. I'd love to know what would be helpful information for folks. Anything I mentioned in here, any websites I will also make sure to link because you'll want the things like the NPI website, the CAQH website and some of the other things that I mentioned. Oh, that was a lot of information.
Speaker 1:All right, with that comes the conclusion of the 411 on insurance credentialing. Hope this gave you some clarity on if you should take insurance and, if you do, what to do and how to do it. Make sure you are subscribed so you know when the next episode will be coming out and staying up to date on our newsletter as well, which will give you some quick info about the episodes to come. Thanks for tuning in today. I will see you next time. Bye. Thanks for listening to the RD to CEO podcast. Be sure to check out the show notes for any resources mentioned or find more at wwwrdtoceocom. Never miss an episode by subscribing wherever you get your podcasts. See you next time.
