What is credentialing?
Credentialing is the process of verifying the qualifications of a practitioner. Credentials are documented evidence of a provider’s licensure, specialties, education, work history, professional liability insurance, and any malpractice or sanction reports. For NPs and MDs, this also includes DEA registration and board certification. Alma collects, reviews, and submits these materials to insurance payers on your behalf.
Alma’s credentialing process enables members to be in-network with insurance payers and grants access to enhanced payback rates under Alma’s tax ID.
Who can you be credentialed with in Alma’s insurance program?
Alma is currently partnered with Optum (which includes United Healthcare, Oxford, Oscar, and United Healthcare Student Resources), Aetna, and Cigna. In order to be eligible for payment under Alma’s insurance program, you must be licensed and credentialed under Alma for any state in which you wish to submit claims. A full list of payers and geographies can be found here.
If you're interested in becoming credentialed with one of our insurance partners, need help managing your CAQH profile, adding a license, or altering your practice locations at Alma, please fill out this form: Alma Insurance Program - Update Form (only submit this form if you have already submitted your Insurance Onboarding Form).
Who can I see when credentialed with Alma’s insurance program?
Once you have been successfully credentialed with an Alma insurance partner(s), you can see clients who have in-network insurance and who will be physically located in a state where you are both licensed and credentialed when receiving care.
You can read more about in-network insurance payers and Alma’s current geographies in our support center: Payers and Geography.
If you plan to see insurance clients across more than one state, you must indicate each state license you plan to operate under by including this in the Insurance Onboarding Typeform that you complete as part of your onboarding. This allows the Alma team to credential each of your licenses with any insurance payers you’ve requested to work with via our program. If you have another license you’d like to credential, you can submit that information to us here (only submit this form if you have already submitted your Insurance Onboarding Form). You can read more about seeing clients across different states here: Cross-State Licensure Rules.
What is CAQH ProView and why do I need an account?
CAQH ProView is a platform that consolidates commonly requested provider information to simplify the credentialing process. Alma members are asked to create an account (username, password, and security question) and our team handles the rest. Once we receive your login information through the Insurance form, our team will complete your CAQH ProView profile on your behalf.
How do I create a CAQH Proview account?
To set up your account, visit https://proview.caqh.org/PR/Registration
For more information, please refer to the CAQH ProView Reference Materials. The document entitled “CAQH ProView Provider User Guide v32” includes detailed instructions about account setup in Chapter 2 (pages 4-8).
CAQH also offers other products and services to organizations, so it is important that you register for a CAQH ProView account as individual provider, otherwise your credentialing may be delayed.
I already have a CAQH ProView account, but the account was set up by another group that I work with. How can I figure out what my username and password is?
Please reach out to the CAQH HelpDesk at (888)-599-1771. Their support team can help you find the username and password currently associated with your account. You may be asked to provide your NPI number, PLI policy number and expiration date, or your social security number to recover your CAQH details.
My CAQH ProView account was set up by another group and is linked to my non-Alma credentials. Will Alma’s use of my profile interfere with my other credentials?
We do not make any changes to the existing information on your CAQH profile without your permission. If our team encounters information that is out of date or incorrect – for example, if your license number is correct, but the expiration date shows an expired license – we would change that on your behalf to the updated, verified expiration date.
If you are hesitant about giving our team access to your CAQH ProView account, you are welcome to complete your CAQH profile on your own. Please indicate that you have already filled out your CAQH on your insurance form.
What is professional liability insurance and how does it differ from other types of insurance that I might have?
Professional liability insurance is a requirement for providers in Alma’s insurance program. It helps protect you against malpractice claims, lawsuits, grievances from regulatory boards, and more. Professional liability insurance is not the same as general liability insurance or cyber liability insurance.
What are the professional liability insurance requirements for Alma’s insurance program?
To participate in Alma’s insurance program, we ask that you have a current professional liability insurance policy (as of your IPA start date) with coverage amounts of 1 million (per claim) and 3 million (aggregate) that covers the license under which you are practicing.
I have professional liability insurance, but it doesn’t meet those requirements. What should I do?
Fortunately most insurers can easily update your coverage to meet Alma’s requirements. For most insurers, changes to your coverage go into effect within 1-2 business days after a request is submitted. You will need to discuss your options directly with your insurance to determine next steps.
Do I need professional liability insurance for each state that I practice in?
Most professional liability insurance policies provide nationwide coverage. However, we always recommend confirming the terms of your policy by contacting your insurance carrier directly.
Where do you recommend I get my professional liability insurance?
Alma does not make official recommendations regarding professional liability insurance, but members in Alma’s insurance program have recommended:
- CPH & Associates
- Trust Risk Management Services
- Lockton Affinity
- NASW Risk Retention Group (LCSWs only)
How long does it take to be credentialed?
Once our team receives your completed Insurance Onboarding Form details, your credentialing can take up to 45 business days. We do everything we can to expedite the process and will always reach out if there is any additional information we need from you!
I've already been credentialed with one or both of these payers. Shouldn't that make this process go faster?
No, your past credentialing history will not have an impact on your credentialing timeline.
I’m currently seeing clients via teletherapy out of my home. Does that mean you will need to use my home address to credential me?
No, Alma does not have to use your home address if you normally would see your clients in person at another location. In order to protect your privacy, we are happy to credential you under our Alma location for your specific state license or licenses. Please let us know if you offer in-person care so that we can add your physical office address as one of your credentialed locations!
How will I find out when I'm credentialed?
You will receive an email from our team once your credentialing is complete! This email will include the date on which you can begin seeing in-network clients with the payers you've enrolled with. This is also the date that Alma can start submitting claims on your behalf.
I received an email to let me know I'm credentialed, but my credentialing effective date is in the past. Can I submit claims retroactively?
Sometimes a payer will backdate a credentialing effective date, so your credentialing date may have already passed. In this case, if you have been seeing clients with that insurance, you may submit a backdated claim if:
- A client’s plan details have been verified by Alma
- You have not already submitted their claims under a non-Alma tax ID
You can submit backdated claims for these sessions under the “Claims” section in the Alma portal, so long as they fall within the “timely filing” timeframe of 45 days from the date of the session.
If you’ve already submitted claims for these sessions, please do not try to resubmit them through Alma. This often leads to the claim being denied. We recommend that you leave these claims to be processed by whichever means you originally submitted them and use the Alma portal to submit claims for insurance clients going forward.