RDs getting in-networkPDF · 2 pagesFree

Credentialing checklist for dietitians

What to have ready, the order to apply in, where each payer takes applications, how long it runs, and what to set up once you're approved.

What’s inside

• What to have ready: NPI Type 1 (and Type 2 for a group), taxonomy 133V00000X, license, CDR, malpractice, W-9, work history, EFT details, CAQH and a Medicare login.
• The order to file in and what runs in parallel: Medicare, each commercial payer and state Medicaid at once, once CAQH is complete.
• Timelines by payer as published by Medicare, UnitedHealthcare, Cigna, Aetna and Humana, clearly marked "varies, ask the payer", and what the in-network effective date means.
• Where to apply for Medicare (PECOS), your local Blue plan, Aetna, UnitedHealthcare, Cigna, Humana and state Medicaid, with a checkbox per payer.
• What to set up after approval (ERA, EFT, fee schedule, CAQH attestation, recredentialing) and the mistakes behind CO-B7, CO-170, CO-242 and CO-16.