What Information to Have Ready Before Starting Credentialing

Insurance credentialing can feel deceptively administrative—until you’re in it. Missing information, unclear business structure, or incomplete documentation can delay credentialing for months and directly impact when (or if) you get paid.

Whether you’re opening a private practice, joining a group, or expanding services, having the right information ready ahead of time can make credentialing far smoother. Below is a practical guide to what to have in place before you start the process.

1. Laying the Foundation

Before credentialing begins, payers expect that your business is legally and operationally sound.

Business Structure

Decide how your practice is structured:

• Sole proprietorship

• LLC

• S-Corp

In Kentucky, many providers register through Kentucky One Stop. This is also the stage where consulting with an accountant, CPA, or attorney is strongly recommended. Your business structure affects taxes, liability, and how you credential with insurance panels.

Licensing & Insurance

Make sure you have:

• An active, unrestricted state license

• Professional malpractice insurance

• Potentially general business liability insurance (this is often a great question for an attorney)

Credentialing cannot proceed without proof of active licensure and insurance coverage.

NPI & Tax ID

You’ll need:

• NPI (National Provider Identifier)

  • Individual NPI for solo clinicians

  • Organizational NPI if operating as a group practice

• EIN (Employer Identification Number) for tax purposes (even if you’re solo) 

Financial Setup

Before credentialing, it’s best practice to:

• Open a separate business bank account

• Consider basic bookkeeping software or support

Insurance payments should never flow through a personal account.

2. Office Space

Insurance panels require clarity on where and how services are delivered.

Be prepared to specify:

• Home office

• Rented or shared office space

• Telehealth-only practice

Physical office location and billing/remit address are required for credentialing, these do not have to be the same

Your practice address must match across:

• CAQH

• Insurance applications

• IRS records

• Licensing boards

Inconsistencies here are a common cause of delays.

3. Legal & Ethical Considerations

Credentialing assumes that your practice is operating ethically and in compliance with state and federal regulations.

HIPAA Compliance

You must be able to demonstrate:

• HIPAA-compliant communication

• Secure record-keeping

• Appropriate use of email, EHRs, and telehealth platforms

Informed Consent & Policies

You should have clearly defined:

• Informed consent documents

• Confidentiality policies

• Cancellation and no-show policies

• Intake paperwork

• HIPAA acknowledgements

I strongly recommend consulting with an attorney to review or help draft intake paperwork and policies.

State & Medicaid Regulations

Kentucky providers should stay up to date on:

• State-specific behavioral health regulations

• Medicaid rules, including

  • KY Medicaid Provider Type Summaries

  • DMS Behavioral Health Fee Schedules

These details directly impact how (and if) you can bill certain services.

4. Insurance Credentialing Decisions

Credentialing isn’t just paperwork—it’s a strategic choice.

Insurance vs. Private Pay

Decide whether you will:

• Accept insurance

• Operate as private pay only

• Use a hybrid model

This decision affects everything from documentation requirements to revenue predictability.

CAQH

Most commercial insurance panels require an up-to-date CAQH profile, including:

• Licensure

• Education and work history

• Insurance coverage

• Practice locations

Keeping CAQH accurate and attested is essential.

Kentucky-Specific Panels

If you plan to accept insurance, consider what payers you’d like to be in network with:

• KY Medicaid

• Managed Care Organizations (MCOs)

• Commercial insurance plans

• Medicare Advantage plans

• Traditional Medicare

Each has different timelines, requirements, and some have ongoing required maintenance.

5. EHR Setup & Billing Readiness

Credentialing and billing go hand-in-hand.

Choosing an EHR

Your Electronic Health Record should support:

• Insurance billing

• Secure documentation

• Reporting and audits

Many providers use platforms like SimplePractice, but the best EHR is one that aligns with your workflow and billing needs.

Billing Infrastructure

Before credentialing, ask:

• Who will submit claims?

• Who will follow up on denials?

• How will payments be tracked and reconciled?

Credentialing without a billing plan often leads to lost or delayed revenue.

6. Sustaining & Growing Your Practice

Continuing Education

Maintain licensure through:

• Required CEUs

• Ongoing professional development

Scaling Up

If growth is on your horizon, consider:

• Group practice expansion

• Hiring clinicians

• Creating standard operating procedures (SOPs) for onboarding

Creating clear SOPs for onboarding and credentialing new clinicians is something I frequently help practices with.

7. Marketing & Networking Foundations

Branding

Have basics in place:

• Website

• Professional bio

• Clear service descriptions

Networking & Visibility

Many Kentucky providers connect through:

• Psychology Today

• Professional organizations and memberships, such as:

  • NASW-KY

  • Kentucky Society for Clinical Social Work (monthly peer consultation group)

  • Lexington Psychoanalytic Study Group

These connections can support referrals and professional credibility.

8. Get Your Team Together

A strong support team often includes:

• Attorney

• CPA

• Bookkeeper

• Consultant

It’s important to vet these professionals and work with people you trust. The right team saves time, money, and unnecessary stress.

Need Support with Credentialing?

Credentialing can be one of the most time-consuming and confusing parts of building or growing a practice—especially when it’s layered on top of clinical work, documentation, and day-to-day operations.

If you’d prefer to focus on seeing clients while someone else manages the timelines, portals, and follow-up, I offer credentialing support for behavioral health providers and organizations, including:

• Initial credentialing

• Recredentialing

• Panel expansion

• Support for group practices onboarding new clinicians

Whether you’re just getting started or scaling an existing practice, having the right support can prevent delays and lost revenue.

 You don’t have to navigate this process alone.