Becoming A Dietitian: Navigating Insurance Affiliations

Dietitians can offer comprehensive medical nutrition therapy to help clients improve their health. While some private healthcare insurance policies may cover registered dietitians, federal insurance programs offer limited coverage that varies across states.

There are two key steps to getting set up with insurance: credentialing and contracting. To become an in-network provider, or credentialed with the carriers of your choice, you'll need an Employer Identification Number (EIN), a license (if required in your state), a National Provider Identifier (NPI), and professional liability insurance.

The credentialing process can be long and frustrating, even if you use an insurance credentialing service like CAQH. It's important to do your research and determine which insurance companies will best support your practice's goals.

Determine your business entity

When determining your business entity as a dietitian, there are several options to choose from, each with its own advantages and considerations. Here is an overview of the different business entities to consider:

Sole Proprietorship

A sole proprietorship is the simplest business structure, where the business is owned and operated by a single individual. This structure offers simplicity and flexibility in management and decision-making. However, it's important to note that the owner's personal assets may be at risk in the event of business-related issues.

Limited Liability Company (LLC)

An LLC is a popular choice for many businesses due to its ability to provide protection for personal assets. In an LLC, the business owners are not personally liable for the company's debts or liabilities. This structure offers flexibility in management and taxation, and it is often recommended for businesses with a significant level of risk.

Partnership

A partnership is when two or more people agree to share ownership of a business, contributing their skills, resources, and capital. Partnerships can benefit from the combined expertise and resources of the partners, but it is important to establish a clear partnership agreement to outline the rights and responsibilities of each partner.

LLC Taxed as an S Corporation

In this structure, an LLC elects to be taxed as a corporation, which means the business income and expenses are passed through to the owners, who then report them on their personal tax returns. This can provide tax advantages, such as potentially lower self-employment taxes, but it also comes with additional requirements and complexities.

When determining your business entity, it is essential to consider factors such as liability protection, taxation, management structure, and compliance requirements. Consulting with a legal professional or a business advisor can help you make an informed decision that aligns with your specific circumstances and goals.

Additionally, it is worth noting that the requirements for becoming affiliated with insurance companies as a dietitian may vary, and it is important to refer to the specific guidelines provided by those insurance companies. They may have their own set of criteria and steps that you need to follow to establish your business entity and successfully work with them.

Get an Employer Identification Number (EIN)

To become affiliated with insurance companies as a dietitian, there are several preliminary steps to take before starting the application process. One of these steps is to get an Employer Identification Number (EIN).

An EIN is a unique nine-digit number assigned to a business entity by the Internal Revenue Service (IRS). It is used to identify the business for tax reporting purposes, similar to how a Social Security Number (SSN) is used for individual residents. All businesses that meet certain criteria must obtain an EIN before they can begin operating. This includes businesses that have employees, operate as a corporation or partnership, file certain tax returns, withhold taxes on income paid to non-resident aliens, or have a Keogh plan. Additionally, individuals involved with organisations such as trusts, estates, and non-profits will also need an EIN.

The process of obtaining an EIN is fairly straightforward and can be done online, by phone, fax, or mail. It is important to note that the application must be completed in one session as it cannot be saved and returned to. Once all validations are done, the EIN will be issued immediately. There is no cost associated with applying for an EIN.

To apply for an EIN, you will need to fill out Form SS-4: Application for Employer Identification Number, which is available on the IRS website. The form will require information such as the name of the company's principal officer, the start or acquisition date, and the principal industry of the business. Additionally, the person responsible for the business must be an individual and not an entity, unless it is a government entity.

It is worth mentioning that an EIN is different from a Tax Identification Number (TIN), which is a broader term used to describe any type of identification number. An EIN is a specific type of TIN.

By obtaining an EIN, dietitians can not only meet the requirements for working with insurance companies but also facilitate various aspects of their business operations, such as hiring employees, opening bank accounts, obtaining credit, and maintaining corporate shields.

Get a National Provider Identifier (NPI)

To become affiliated with insurance as a dietitian, there are several preliminary steps to take before filling out the CAQH application. One of these steps is to get a National Provider Identifier (NPI). The NPI is used to identify a healthcare provider in standard transactions, such as healthcare claims. It is also used to identify healthcare providers on prescriptions, in internal files, in patient medical record systems, and in other ways.

There are three ways to apply for an NPI:

• Mail in a written application.
• Through an electronic file interchange provided by a large organisation.
• Online application: This is the fastest and easiest way for most physicians. To complete the online application, you will need:

• Legacy (current) provider identification numbers
• Mailing address and practice address(es)
• Phone number and the name of the contact person
• Country and state of birth, date of birth, and social security or individual taxpayer identification number

If you already work for an institution or another private practice, they have likely already obtained a Type 1 NPI for you. A Type 1 NPI is tied to your social security and legal name. However, if you do not already have an NPI, you can apply for both a Type 1 NPI for yourself as an individual and a Type 2 NPI for your organisation on the same site. Your Type 2 NPI will be an identification number for your organisation and will be tied to your LLC.

It is important to note that you must notify the enumerator of any changes to your information within 30 days of the change. Most changes will not change your NPI number, and you will only be issued a new number in rare circumstances, such as fraudulent use of your NPI.

Get liability insurance

Liability insurance is a crucial step in becoming affiliated with insurance companies as a dietitian. It is a requirement for becoming an in-network provider, or "credentialed" with insurance carriers. This type of insurance protects you in the event of a claim being made against you and covers defence costs, judgments, and settlements, as well as lost wages while defending a claim.

The cost of liability insurance varies depending on your location and the coverage limits you choose. For example, in Connecticut, a dietitian pays around $120 per year for liability insurance. The Academy of Nutrition and Dietetics offers discounted liability insurance for dietitians through Mercer Consumer Professional Liability Insurance.

When applying for liability insurance, you will need to provide certain information, including your basic personal information, education and training details, and any specialties or certifications you hold. You may also be asked about your business structure, tax ID, and National Provider Identifier (NPI).

It is important to note that the process of obtaining liability insurance and becoming credentialed can be time-consuming and tedious, so it is recommended to approach it with patience. Additionally, some insurance companies may have specific requirements, such as a certain level of coverage or a particular type of NPI. Therefore, it is essential to carefully review the requirements of each insurance company you plan to work with.

Fill out the CAQH application

Filling out the CAQH application is a crucial step in the process of becoming affiliated with insurance companies as a dietitian. CAQH, which stands for "Council for Affordable Quality Healthcare", serves as a centralised database for providers to securely store their information. This allows insurance companies to easily access and review provider details during the credentialing process. Completing the CAQH application typically takes a couple of hours, and it is important to ensure that all information provided is accurate and up-to-date. Here is a detailed guide on how to fill out the CAQH application:

Obtain your CAQH ID:

Request a CAQH ID by registering on the CAQH website. This process can take up to 3 business days, after which you will receive your ID via email.

Set up your secure credentials:

Create a secure username and password for your CAQH account. Ensure that your password is unique and meets the password requirements.

Complete the online application:

The CAQH application will require a range of information, including basic personal information, education and training details, work history, practice location information, and malpractice insurance information. It is important to have all this information readily available before starting the application. Take your time to carefully enter the information, ensuring accuracy and avoiding any typos.

Upload supporting documentation:

In addition to the online application, you will need to provide supporting documentation. This includes copies of licenses, malpractice insurance, and other relevant certificates. Make sure to have scanned copies of these documents ready for upload.

Review and attest to your application:

Once you have completed the online application and uploaded all the required documentation, carefully review all the information. Ensure that everything is correct and accurate. Then, attest to your application data, certifying its accuracy.

Grant insurance companies access:

After completing and attesting to your application, you will need to grant insurance companies access to your online application. This is an important step as it allows them to review your credentials during the credentialing process.

It is important to note that the CAQH application does not need to be completed in one sitting. You can save your progress and return to it later if needed. Additionally, remember to regularly re-attest to your information, as this is required quarterly.

Frequently asked questions