Credentialing
Every portal, in order, so you don't have to guess.
Getting credentialed means moving through a handful of separate websites in the right sequence. Here's what each one is for, and which parts I handle for you.
The screens below are simplified illustrations of each site, not screenshots of the real portals. They're here to show you the shape of the process. Nothing you see is real account data.
Get your NPI
Your National Provider Identifier is the number every payer uses to identify you. It's issued through NPPES, and nothing else in this process can start without it.
- Individual NPI (Type 1) for you as a clinician
- Organization NPI (Type 2) if you're billing as a practice
- Taxonomy code that matches your license type
Who does it: I can apply on your behalf, or verify the one you already have.
Get your tax ID
An EIN from the IRS is how your practice gets paid as a business rather than under your Social Security number. If you've formed an LLC or PLLC, this is the number that goes on your claims.
- EIN application through the IRS
- Matching your legal business name exactly
- Keeping your NPI and EIN records consistent
Who does it: Included in Medicaid credentialing if you don't have one yet.
Register with Colorado Medicaid (HCPF)
The Department of Health Care Policy & Financing runs Colorado's Medicaid program. Provider enrollment here is what makes you a recognized Medicaid provider in the state.
- Provider enrollment application
- License, insurance, and disclosure documentation
- Responding to any revalidation or correction requests
Who does it: I handle the application and any follow-up the state sends back.
Credential with your RAE
Colorado routes behavioral health through Regional Accountable Entities. Being enrolled with the state isn't enough. You also need to be credentialed and contracted with the RAE that covers the region where your clients live.
- Choosing the RAE that matches your service area
- Credentialing packet and contracting paperwork
- Confirming your effective date before you bill
Who does it: One RAE of your choice is included in the $300 Medicaid credentialing.
Enroll with Medicare in PECOS
If you want to see Medicare clients, enrollment happens in PECOS. This is a separate track from Medicaid with its own application and its own effective date.
- PECOS registration and enrollment application
- Reassignment of benefits, if you bill under a group
- Linking your billing system to Medicare so claims can flow
Who does it: This is the $200 Medicare and Private Insurance companies service.
Connect your billing system
Last step: your billing platform has to be able to reach each payer. That means enrollments for electronic claims and remittance, and a test claim to prove the whole path works before we rely on it.
- Setup in Availity, Reliatrax, or Office Ally
- Electronic claim and remittance enrollment per payer
- A test claim end to end before we go live
Who does it: I do, and I stay on it until a claim actually pays.
Good to know
Credentialing questions
How long does credentialing take?
The timeline belongs to the payers, not to me. Each one processes applications on its own schedule, and a missing document can restart the clock. What I can promise is that your application goes in complete the first time and that I follow up on it. At your consultation I'll tell you what to expect for your specific situation.
Can I see clients while my application is pending?
Sometimes, depending on the payer and your effective date, but claims for sessions before that date usually can't be paid. Talk to me before you start seeing insurance clients so you don't end up working for free.
I'm already credentialed but claims aren't paying. Can you help?
Yes, and it's a common call. Often something in the enrollment chain never finished: a payer connection that was never activated, or a taxonomy that doesn't match. That's a good use of a one-hour consultation.
Do you credential with commercial payers too?
Yes. Credentialing with Private Insurance companies like BCBS, Aetna, Cigna, Tricare, and United is included in the $200 Medicare and Private Insurance companies service. Just tell me which ones you want.
Credentialing support
Skip the portals.
Send me your details once and I'll take it from the first application to your first paid claim.