Getting Started with Insurance: What You Actually Need

Written By Janell Mihelic

Congratulations, you’ve decided to bill health insurance. This article is designed to help you get started with the first two steps: assembling the necessary foundational documents and approaching credentialing in a manageable way.

Much of the guidance around insurance credentialing is either overly technical or unnecessarily alarming. In reality, the process is more approachable than it’s often made to seem, especially when you focus on the essentials first. Below, we outline what you need to get started and practical ways to approach credentialing, without overcomplicating the process.

 

What You Need Before Credentialing

Before applying to any insurance panel, there are several foundational items that must be in place. At minimum, you’ll need:

  • An active professional license in good standing

  • NPI (Type 1)

  • CAQH profile (completed and regularly attested)

  • Professional liability insurance meeting payer minimums (commonly $1M per occurrence / $3M aggregate)

  • Tax ID (i.e., EIN)

  • Practice address and contact information

  • Business bank account (and physical checks, as required by payers)

  • An EHR or documentation system that supports insurance-based care

If you plan to credential as a group or employ other clinicians, you may also need:

  • NPI Type 2

 

Credentialing vs. Contracting: A Helpful Distinction

Many clinicians use “credentialing” as a catch-all term, but it’s helpful to distinguish between two related processes:

  • Credentialing verifies you (license, education, training, and background)

  • Contracting establishes the financial agreement with the insurer

Credentialing comes first. Once approved, the insurer issues a contract for review and signature. Both steps take time. On average, credentialing can take three to six months, though timelines vary by payer and region.

 

Choosing Where to Start

You do not need to credential with every insurance plan at once. A more sustainable approach is to:

  • Start with one or two major payers in your area

  • Prioritize plans your referral sources and community commonly use

  • Consider reimbursement rates alongside demand

Some clinicians begin with Medicaid, others with large commercial carriers, and some delay insurance participation entirely until their practice is more established. There is no single correct order.

When deciding which insurance companies to pursue, consider:

  • Which plans are most common in your area

  • Which insurers require frequent prior authorizations (often a meaningful administrative burden)

  • Your state’s Medicaid reimbursement schedule and how it compares to commercial plans

  • Your intended population:

    • Older adults → Medicare

    • Military members → TRICARE

We also recommend diversifying pay sources when possible. For example, accepting one government insurance (e.g., Medicare, Medicaid, or TRICARE) and one commercial payer (e.g., BCBS, Cigna, UHC) can help balance access and sustainability.

Notably, many clients have out-of-network benefits, allowing them to see providers who are not credentialed with their insurance and still receive partial reimbursement. Government insurance programs typically do not allow this.

 

Approaches to Credentialing

There are several common ways clinicians approach credentialing:

1. Self-Credentialing

This involves completing applications directly through payer portals and CAQH. It costs time but no money and offers the greatest control.

Best for clinicians who:

  • are detail-oriented

  • have time to track follow-ups

  • want to understand the system firsthand

  • have prior insurance experience

2. Using a Credentialing Service

Credentialing companies manage applications and follow-ups for a fee. Quality varies, and outcomes still depend on accurate information from you. Fees commonly range from $250–$450 per application.

Best for clinicians who:

  • are short on time

  • prefer delegation

  • want administrative support without full outsourcing

Some EHRs (e.g., SimplePractice) now offer built-in credentialing services.

3. Hybrid Approach

Many clinicians self-credential initially and use credentialing services selectively as their practice grows.

4. Credentialing Through a Larger Organization (1099 Model)

In recent years, platforms such as Alma have expanded access to insurance participation by credentialing clinicians under a larger organization’s contracts.

Alma is a membership-based platform that supports clinicians in participating with select insurance networks by managing credentialing, contracting, and certain administrative functions. Clinicians credential through Alma’s group contracts rather than independently with each payer.

In exchange, clinicians pay a monthly membership fee and accept standardized reimbursement rates.

Alma may be a reasonable option for clinicians who:

  • want to reduce administrative work

  • prefer not to manage credentialing independently

  • are comfortable with standardized rates

  • value faster access to insurance participation

Final Thoughts

Working with insurance is neither a trap nor a shortcut, it is simply one of many practice models. Starting small, staying organized, and focusing on fundamentals makes the process far more manageable than most clinicians expect.

The goal is not to do everything at once, but to build a foundation that allows your practice to grow thoughtfully and sustainably.

Janell Mihelic