For Therapists Starting a Private Practice
Venturing into the New:
Starting a private practice with the intent of being able to accept insurance has been wildly complicated and confusing. With some fore knowledge of specific and important administrative details, at least some of that confusion could have been circumvented for me. I’ll share what I’ve learned stumbling around the labyrinth of Wisconsin bureaucracy. Please know that I am far from an expert. What I write is just based on my anecdotal meanderings as I navigate starting my practice. I hope for what I write to be helpful and a start to a conversation that may also help me to learn more. I certainly have a lot more to learn.
Before launching on my own, I wish I had known the following:
CAQH and Forward Health
My former practice had the username and password to access my CAQH (now called Data Spring) account and my Forward Health Portal.
Link to Data Spring provider login: click here
Link to Forward Health Provider login: click here
Prior to my last day with my prior practice, I wish I had asked for my username and password for these two sites. (I have them now, but it was a convoluted journey to get them.) Additionally, in order to make any changes to my profile in either of these sites, the system wants to do a two-factor authentication. These profiles had my prior practice’s credentialing team’s email and phone number so I could not save any profile changes. With CAQH, I spent time on the phone with them and was able to get the ability to manage my own profile. I am still working on getting the ability to edit and save my Forward Health profile. Prior to my last day with my previous practice, I wish I had asked for the credentialing people to please replace their email and phone number with my email and phone number.
NPPES
Here is the link to the NPPES provider login: click here
If you mess up your password too many times and have your NPPES profile locked, there is an AI assistant tool that can help you get it unlocked. I spent a long time on hold trying to call their support number. I never did reach a person.
Here is the link to the AI tool: click here
The AI tool looks like a little text bubble in the lower right side of the page. It says, “Need help? Chat support is available”. Good luck. I hope you never lock yourself out.
I actually don’t know remember what hoops I jumped through to initially login to my NPPES profile. It is important, I think, to note that the password will expire and lock you out after a certain number of days.
More about the NPI
I learned that there are NPI 1s and NPI 2s. Even though I plan to be the sole proprietor of my LLC, I’ve learned that some insurances will want me to have an NPI 2. So I applied for an NPI 2. Applying for an NPI 2 was free and it didn’t take long. I just needed to login to my NPPES account in order to do it. (I did it yesterday so I don’t know how soon I will be able to say I have an NPI 2. I can’t say it yet.)
You might wonder, ‘what is the administrative difference for the private practice owner between having an NPI 1 and an NPI 2? Likely there is more than I know, but what I’ve learned so far is that with an NPI 1, insurance bills and you pay business taxes using your social security number. With an NPI 2, insurance bills and you pay business taxes using your Private Practices’ EIN number.
The LLC:
I chose the name Blossoming Wellness for my LLC because I liked it. I like the transformation metaphor for personal growth. First, I formed the business by getting articles of incorporation. As a separate step, I went to the IRS website and applied for an EIN number for my LLC. It did cost money to get the articles of incorporation. There are options to get help with creating the articles of incorporation. I did it on my own and I think I did fine. I’m certainly not qualified to help others make decisions about the process.
Credentialing with Insurance:
I have learned that, whether you are doing your own credentialing, paying someone to do credentialling, or using one of the free credentialing platforms you will need the following:
LPC license number (via DSPS)
proof of liability insurance information (1,000,000 per occurrance and 5,000,000 aggregate)
NPI number, username, and password (via NPPES site)
CAQH number, username, and password (via Data Spring site)
A HIPPA compliant business phone number
A HIPPA compliant email
a copy of your ID/drivers license
a current resume/cv
possibly your transcripts form grad school
EIN
Other things to choose and establish:
HIPPA compliant phone and Fax
HIPPA compliant email
An EHR
A business bank account
A website
A physical address, at least for mail if not for seeing clients
Taxes:
I’ve learned from others that its important to file taxes quarterly instead of once a year. That is all I know about that so far.
Accounting:
This is an area where I have a lot to learn.
Health Insurance for myself and my family:
I was able to get my whole family on Medicaid for now, while I’m not making much money.
How does this compare to other’s experiences?
