Onboarding Process

"*" indicates required fields

1Review Term

2Strategic Alliance Partner’s

3Onboarding Information

I Agree*

I Agree, I'll be working with you for IWC to get you contracted with the insurance companies and add you as a provider to IWC's group contracts. I also manage your CAQH profile to make sure it's current and accurate for all the new applications I'll be working on for you during this process. Would you please complete the attached Provider Info Form as completely as possible and then email me the completed form with the following documents and information (use additional pages or notes as needed):

● Current LCSW license
● Current Malpractice Insurance
● Masters Diploma
● Resume or CV
● Picture of current Driver's License
● Copies of any other applicable certifications
● Home Address
● Other names you have gone by (personally and professionally)
● List of three professional references (if not already in your CAQH profile)

This is the list of insurance companies I will be working to add you to (please advise me if you are already contracted with any of these):

Medicare (Reassignment 855R to IWC)- If you are already contracted with Medicare or have a PECOS login, please forward that info to me on your Provider Info Form. If you haven't logged into PECOS lately you may have to reset your password. It's recommended to add my office phone (530) 474-6094 (voice call only) as an alternate method of account verification (allows me to login and get a security code without bothering you). If you don't have a CMS I&A Account, I'll work on creating it for you and advise you of any required steps. Or please use this link to create your login and then send me the Username and password https://nppes.cms.hhs.gov/IAWeb/warning.do

Healthnet/MHN Tricare HNFS (Healthnet Federal Services)

United Healthcare/UBH/Optum (will need to create a OneHealthID login; I'll instruct when your help is needed to verify the account I can create if you don't have one already) This is a new contract for you as an Individual Provider that you must approve and sign directly. Then once approved, I link you to IWC's group as an approved provider. This is new for all SAC's this month as I am starting to work on these. This will be a new experience for all SAC's and myself.

Kaiser

Once you have your Protonmail.com address, please use it to send me your info. The sooner I get all your completed info, I can move forward. The sooner the better since the process can take 60-120 days. No referrals can be made until you are "approved" by each plan. Medicare should only take about 30 days if all info is current.

Session Activity Log--attached is the activity log you may have already been given by Katerina. Some tips on using it:

1. Use complete patient names (first and last)
2. Dx's are only required on initial session logs or if you are changing the Dx for a particular session.
3. Minutes in therapy--this helps me make sure I use the correct CPT codes or bill patients correctly.
4. Send to me (via protonmail) after each complete week of activity and cc Veronica and Katerina (Mondays are preferred, but if you have a short week you can send it prior to that)
5. Save as a Word or PDF type doc. I use a PC so it must be one of these types of files. Put the date sent in your file name.

Feel free to email or call me with any questions during the setup process. Welcome aboard, I look forward to working with you.

Victoria House, Billing & Credentialing Manager/Owner

House Medical Billing Service LLC

vhouse@housebilling.com (530) 474-6094

Fax (866) 849-0672 www.housebilling.com

Strategic Alliance Partner’s Name*

Date*

Phone Number to be used for Pt and IWC contact*

Email address*

New Proton Email*

(please go to Protonmail.com and set up your free HIPAA compliant email. You can send this to us at a later date and we can add to your profile. All communication related to patients is to be used on protonmail for patient confidentiality)

Address*

License and License*

Weekly Patient Case Load*

Age Range*

Preferred Pateints*

Will you see Couples*

Will you see Vetrans*

Modalities used (CBT, EMDR, ETC.)*

What days and hours will you be seeing Clients*

Would you like IWC to book your patients TherapyNotes or would you be booking your own patients*

Name:*

Title of Licensure*

Mailing Address*

Physical Practice Address*

Additional Location*

Phone:*

Fax:*

Other:*

Email:*

Date of Birth*

Office Hours*

Monday

Tuesday

Wednesday

Thursday

Friday

Weekends

Fee Schedule—Please send your practice’s CPT code list with your rates

New Proton Email*

Highest Degree Earned*

Credentials*

Level of Insurance Coverage*

Name of Insurance Carrier*

Social Security#*

Federal Tax ID# (EIN#):*

*NPI#*

Type 2NPI#*

License #*

DEA#*

Insurance Contracts (In Network)--Please check all insurance co’s you are contracted with:

Medicare PTAN:*

Medicaid ID#*

CLIA CERT#*

Anthem:*

Aetna:*

Blue Shield of CA:*

Cigna:*

Health Net/MHN:*

Beacon/CHIPA:*

Magellan:*

Beacon/ValueOptions:*

United Healthcare/Optum:*

Other:*

Provider Logins (continue on next page if needed) Make sure all logins are accurate and passwords current:

CAQH ID#*

Password*

Ins Name:*

User Name:*

Pswd:*

InsName:*

UserName:*

Pswd:*

CAPTCHA

This field is for validation purposes and should be left unchanged.

EVENTS

Ready to take the first step towards your wellness?

About

Preoperative Bariatric

Vitamin Wellness Eval

CBD Consultation

HRV Assessment

Services

Psychotherapy

Grief Guidance

Coaching

Groups and Workshops

Reiki

Specialities

BrainTap

Weight Management

Mindfulness Workshops

More Links

Contact Information

Subscribe To Our Newsletter