Insurance Credentialing for Your New York PLLC

Get an NPI for the PLLC

You already have an individual NPI (Type 1). Your PLLC needs its own, called an organization or Type 2 NPI. Even a one-person practice needs one, because Medicaid, Medicare and several insurers ask for it when they enroll the practice.

The application is free and goes through NPPES, the federal NPI system. Filed online, it usually comes back within a day. On paper, expect about four weeks.

While you're in NPPES, check your individual NPI too. If it still lists an old license (an LMSW who's now an LCSW, for example) or an old address, insurers may not match your records. Fix that before you apply anywhere.

Know which tax ID goes where

Your PLLC has an EIN. Which number goes on your W-9 depends on how the PLLC is taxed:

• Single-member PLLC with no S corporation election: the IRS treats it as a "disregarded entity." The W-9 lists you on line 1 and the PLLC on line 2, and in most cases uses your SSN.
• PLLC taxed as an S corporation: the W-9 uses the PLLC's EIN.

Some enrollments ask for the EIN no matter what. NY Medicaid wants the PLLC's EIN and the IRS letter that assigned it, not a W-9. Getting this wrong is a common reason applications stall. If you're not sure how your PLLC is taxed, your accountant can tell you.

Set up or update your CAQH profile

Most commercial insurers pull your information from CAQH (now branded DataSpring, powered by CAQH) instead of asking for it again. Your profile needs your PLLC as a practice location, with its address and tax ID.

Two things only you can do: authorize insurers to view your profile, and attest that it's accurate. You re-attest every 120 days, even if nothing has changed. If you miss it, insurers can't use the profile until you attest again.

Apply to insurers, or move your existing contracts

If you're already in network under your own name: each insurer has its own process for linking your contract to the PLLC's tax ID. Some take a form, some take a full new application.

If you're new to an insurer: you apply to join its network, usually after your CAQH profile is attested. Some insurers close their panels in certain areas or specialties and turn away new providers. It isn't personal, but it's worth checking before you pick which insurers to apply to.

Commercial applications commonly take 60 to 180 days from submission to an effective date, depending on the insurer.

NY Medicaid, if you want Medicaid clients

NY Medicaid enrollment is its own process, through the state's Provider Services Portal. Paper applications ended after August 31, 2026. A few New York details:

• You enroll as an individual first. Your PLLC then enrolls as a group, which needs the PLLC's NPI.
• If you want Medicaid managed care plans (Fidelis, Healthfirst and others), you generally need your state Medicaid enrollment first. Those plans won't add you to their Medicaid products without a Medicaid ID.
• LMSWs can't enroll in Medicaid on their own. LCSWs can.
• New York publishes a public list of enrolled providers that includes the service address. If you see clients by telehealth from home, that's your home address. Decide how you feel about that before you file.

Medicaid usually takes longer than commercial insurers.

Medicare, if you want Medicare clients

Licensed clinical social workers can enroll in Medicare, and since January 1, 2024, so can licensed mental health counselors and marriage and family therapists. You enroll yourself and then reassign your payments to the PLLC, so Medicare pays the practice.

If you work from home by telehealth, Medicare lets you list your home as an administrative or telehealth-only location so it doesn't show up in public listings.