Switching to a Group NPI or Independent Billing? Here's Why You Must Re-Credential

This surprises a lot of providers, so here's what you need to know, broken into bite-sized parts:

Part 1: 🎯 What Triggers the Need to Re-Credential?

Credentialing isn’t just about you — it’s also about how you bill.

You must re-credential if:

• You register a new Tax ID (like forming an S-Corp or C-Corp)

• You start billing under a new NPI (e.g., a group or Type 2 NPI)

• You switch from being a rendering provider under a group to being an independent billing provider

Even if you're the same person, the insurance company now sees a new billing entity, and you must start the credentialing process all over.

Part 2: 🏥 Re-Credentialing with Commercial Insurance Plans

You’ll need to reapply with each commercial plan individually (Aetna, Anthem, Blue Shield, etc.).

Here’s what to expect:

• Update your CAQH profile with the new legal name, Tax ID, and group NPI

• Submit new contracts or provider interest forms

• Attach a new W-9 with your business info

• Wait 30–120 days (depending on the payer)

🔁 Tip: While you’re waiting, ask if they’ll allow retroactive effective dates (some do, like Aetna and UHC).

Part 3: 📌 Re-Credentialing with Medi-Cal (DHCS)

This is a separate process and can’t be skipped.

You'll need to:

• Create a PAVE portal account for your business (if you're billing under a group)

• Submit a new Provider Application (e.g., DHCS 6204 for licensed practitioners)

• Wait for approval and a new Medi-Cal billing number

❗Note: Even if you were already seeing Medi-Cal patients, you can’t backbill until DHCS approves you as a billing provider under the new entity.

Part 4: 🧾 What Happens If You Don’t?

If you bill under a new NPI or Tax ID before being approved, you risk:

• Claim denials

• Delayed payments

• Being classified as out-of-network

• Having to refund money later

Even worse, some payers will terminate your old contract once they see a new application.

Part 5: 🚀 How to Stay on Track

Here’s a simple checklist:

• ✅ Register for a Type 2 NPI for your business

• ✅ File your W-9 with new business info

• ✅ Update CAQH

• ✅ Reapply to each payer

• ✅ Create a PAVE portal account for DHCS

• ✅ Keep old and new credentialing dates organized in a tracker

Need help? We’ve got a template for that — Download the Insurance Credentialing Tracker

Final Thoughts

Re-credentialing feels like a paperwork nightmare, but it’s essential if you want to own your practice, your reimbursements, and your independence.

If you’re unsure which steps you’ve done — or which ones you’ve missed — reach out and we’ll walk you through it.