Credentialing

What is a CAQH profile?
CAQH, short for Council for Affordable Quality Healthcare, allows insurance companies to use a single, uniform application for credentialing. It is also utilized by insurance companies as a form of information verification. Almost all health plans require practitioners to complete and attest their CAQH profile before submitting their application.

How often does CAQH need to be attested?
Every 120 days. You will receive a request from CAQH to attest that all the information in your profile is up to date and accurate.

How long does it take to get credentialed with a health plan?
Credentialing can take anywhere from 90-120 days.

Malpractice insurance
Every provider must carry a Professional liability insurance with minimum limits between $1,000,000 – $3,000,000.

Can I be contracted with Managed Medicaid Plans without being a Medicaid provider?
No, you must have a Medicaid number to become a contracted provider with the Medicaid managed plans. Some insurance companies have exceptions for providers who are unable to become a Medicaid provider (i.e. LMHCs).

What is an EIN letter?
A letter provided to you by the IRS. An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number and is used to identify a business entity. The EIN is utilized in place of a provider’s social security number when contracting with insurance plans and submitting claims. EINs can be assigned to a sole proprietor or a group practice.

What is an EFT?
EFT (Electronic Funds Transfer) is the preferred method of payment for health plans. With EFT enrollments, health plans can send payments directly to a provider’s financial institution (direct deposit).

What is an out of network profile?
An out of network profile ensures that your billing and practice information is on file with the health plans if you submit claims to health plans that you are not contracted with. If you do not have an out of network profile, it can lead to a delay in claims payment.

What is an ETIN?
An ETIN is the electronic billing certification required by NYS Medicaid to submit claims electronically. These forms need to be notarized and the original copies are sent to Medicaid. They do not accept scanned documents or electronic signatures. ETINs need to be recertified annually.