The NewGradOptometry Guide to Optometry Credentialing

the ultimate guide to optometry credentialing

Optometry credentialing is one of the most challenging things you’ll need to do in order to start seeing patients. We’ve written small guides before but we’ve finally designed a complete ebook of all our previous walkthroughs of optometry credentialing to cover the entire process. That’s 30 pages, 25+ screenshots, and step-by-step walkthroughs of the most important parts of getting credentialed as an optometrist all for a free download!

If you plan on examining patients who wish to use insurance, you must be a “provider” with their insurance company, and in order to be a “provider” you must get credentialed. Insurances, both medical and vision, have their own credentialing process, which can cause the process to be long, arduous, and, quite frankly, confusing. This ebook is designed to break down the optometry credentialing process for an OD who might want to try and tackle things on their own.

First and foremost, the credentialing process typically takes place after you have applied for and received your license in the state you plan on practicing. So make sure you’ve obtained your license first — if you haven’t, check out our in-depth guide on how to get your license in all 50 states.

So what do you do after you receive your license?

Fill out the form at the bottom of the page to download the full guide!

Here’s the breakdown of what you’ll find in the ebook:

1. Get Your NPI Number

NPI stands for National Provider Identifier, and it’s a unique 10-digit ID number issued by the Centers for Medicare and Medicaid Services to healthcare providers in the US. Note: it’s not your license number.

  • All healthcare plans are required to identify healthcare providers—like you—by their NPI numbers
  • You also need a NPI number for HIPAA transactions
  • Your NPI number can be used in your EMR, as an identifier on prescriptions, and to track unlawful activity

The process of applying for your NPI number is fairly simple, and we’ll walk you through the whole thing in the Guide!

Fill out the form at the bottom of the page to get the full walkthrough!

2. Establish Your Tax ID

Before you complete your optometry credentialing, however, you’ll need to establish your Tax ID. For some of you, this can be your Social Security number if you are working as a solo practitioner or independent contractor. For others, who are applying as a corporation, group or other entity, you’ll need to make sure to set up a Taxpayer Identification Number (TIN), also known as a Tax Identification Number or a Federal Taxpayer Identification Number.

3. If necessary, apply for a Group NPI #

Again, this is necessary if you incorporate or set up a LLC. If you’re not practicing with a group, you can use your individual NPI.

4. Register for CAQH

The Council for Affordable Quality Healthcare, Inc., or CAQH, was formerly known as the Universal Provider Datasource. It is a resource of all of a provider’s information in one place, and it eliminates duplicate paperwork. Almost all insurances except Medicare and Medicaid require that you are registered with CAQH.

Make sure you have all of your documentation in order to register with CAQH!

5. Decide on what vision insurances and medical panels to participate in

Make sure to talk with your community about this. What are other providers in your region credentialed for? What are the insurance providers for larger employers in your region? Do your research.

6. Apply to be a Provider for Medicare

Getting credentialed with Medicare is arduous, but absolutely crucial. You cannot proceed with optometry credentialing with several of the medical insurances until your Medicare is approved or at least processing (including Medicaid in some states).

This is the BIGGEST section of the eBook because it’s the one where there’s the most opportunity for mistakes! It’s also why we’ve compiled over 25 screenshots to walk you through the entire process.

Make sure to download the ebook for the full walkthrough!

7. Begin the Application Process for Other Insurances!

In the ebook, we’ll walk you through getting credentialed with VSP, Eyemed, Davis Vision, and Spectera. These are four of the most common vision insurance plans.

Fill out the form below to download the ebook!


And for further resources, check out the rest of our posts on credentialing, where we’ve covered common questions, listed resources, and more!

About Matt Geller

Matthew Geller
Dr. Matt Geller is a technology entrepreneur with a track record of developing successful online platforms to solve problems in the healthcare space. Matt is an optometrist in San Diego and is the founder of OptometryStudents.com, NewGradOptometry.com and the co-founder of CovalentCareers.com!

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