Credentialing with Insurance Companies In Oregon

I’ve had several people ask me about the steps to be a credentialed massage therapist in Oregon, since it’s already something the state allows (albeit in small, uneven doses). It’s a really easy process, and I wanted to put it all out on this blog for anyone to reference.

First of all, make sure you have an NPI number.

To apply to most insurance companies, you will need the Oregon Practitioner Credentialing Application, which can be found here. Fill out all of the sections that apply to you (many sections, such as Residencies and Hospital Affiliations, do not pertain to LMTs). Keep an unsigned and undated copy of the application in your files, just in case you want to apply to more insurance companies later.

What you will need to submit to the insurance company:

  • Credentialing application
  • Copy of current license
  • Copy of current liability and malpractice insurance
  • Signed W-9 form

Some insurance companies may want you to fill out another form or two (about your specialties, etc), so make sure to look at each company’s website or call provider relations to figure that out. Other companies will want you to fill out the application online instead of sending in a paper copy, which means you’ll have to scan and upload all of the supporting documents.

After you fax or mail in the relevant paperwork to the insurer, it will take upwards of 30 days to hear back. Eventually, you should receive a letter welcoming you into the insurer’s network, along with some new paperwork and a contract to sign and return. And that’s it! Now you’re credentialed. Remember to check on benefits before your client comes in.

(Unfortunately, if the insurance company decides to not let you into their network, they may not tell you – so make sure to call and check up on any that you haven’t heard back from.)

What insurers are big in Oregon?

Below I’ve listed some of the insurance companies that are big in the Portland metro area, as well as those found on the Oregon Exchange*. To find out what insurers are prevalent in your area, talk to your clients and colleagues.

*Please note that insurers whose plans are only available via the Oregon Exchange might not have any plans with massage coverage, and therefore may not be accepting LMTs into their networks at all.

  • ASH: This is a CAM specific insurer that many other insurance companies use. Credentialing with ASH will allow you to work with Health Net, Aetna, and many others.
  • CAQH: Sign up here to get credentialed with Cigna, Optum, United as well as many others (see full list here.) CAQH uses an online form instead of the paper application.
  • The CHP Group: This is a CAM specific insurer that many other insurance companies use, including Kaiser Permanente
  • First Health
  • Lifewise
  • Moda
  • Pacific Source
  • Regence Blue Cross Blue Shield: Joining this network will also give you access to other BCBS health plans.
  • Atrio: A Medicare-specific insurer, serving Douglas, Klamath, and Polk counties via the Oregon Exchange.
  • Bridgespan Health: A new insurer with plans available via the Oregon Exchange. Credential with Regence BCBS (above) in order to work with this company.
  • Oregon Health Co-Op: A new insurer with plans available via the Oregon Exchange.
  • Trillium: Serving Lane county via the Oregon Exchange.