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Credentialing records store your provider NPIs, tax IDs, and linked insurances. Once a credentialing record is created, the NPI will appear in the dropdown when you run an Eligibility Check, saving you from entering it manually each time. Manage credentialing from Settings → Credentialing.

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Quick Start

  1. Go to Settings → Credentialing in your Solum dashboard.
  2. Click “Add Record” to open the creation form.
  3. Fill in the basic info — name, type, and NPI are required.
  4. Link the address — for an organization (entity) NPI, select a location; for an individual NPI, select the provider (their locations come from the provider record).
  5. Add insurances — link the payers this NPI is credentialed with.
  6. Click Create — the NPI is now available in eligibility check dropdowns.
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Credentialing Fields

If you don’t see a location in the dropdown, you need to create it first. See the Locations guide for instructions.

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Creating a Credentialing Record

  1. Go to Settings → Credentialing.
  2. Click Add Record.
  3. Enter a Name for this record.
Use a descriptive name that helps your team identify this NPI quickly, such as “Main Clinic - Entity NPI” or “Dr. Smith - Rendering”.
  1. Select the Type:
    • Entity — Use this for your facility or organization NPI (Type 2 NPI).
    • Rendering Provider — Use this for an individual provider NPI (Type 1 NPI).
  2. Enter the NPI (10 digits).
  3. Enter the Tax ID if available. This is optional.
  4. Link the address: for an Entity NPI, select a Location from the dropdown — this pulls the address from the location you have already configured in Settings → Locations. For a Rendering Provider NPI, select the Provider instead — the record shows the locations set on that provider (Settings → Providers).
  5. Add Insurances by selecting the payers this NPI is credentialed with from the list.
If you don’t see an insurance payer in the list, review the Insurance guide for how to add payers to your account.
  1. Click Create.
The NPI is now saved and will appear in the Provider NPI dropdown when running eligibility checks.

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Adding Multiple NPIs

You can create as many credentialing records as you need. This is common when your practice has:
  • Multiple physical locations, each with their own entity NPI
  • Several individual rendering providers
  • Different NPIs credentialed with different insurance payers
Each record is independent, so you can configure different locations and insurance lists for each NPI.

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Editing a Credentialing Record

Click on any credentialing record to open it for editing. You can update the name, type, NPI, Tax ID, location, and linked insurances at any time.

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How Credentialing Connects to Eligibility Checks

When you run an eligibility check, the Provider NPI field offers a dropdown of all NPIs from your credentialing records. Selecting one automatically fills in the NPI for the check. This means your team does not need to memorize or look up NPI numbers. They select the correct provider or location from the list, and the check runs with the right credentials.
Set up all your credentialing records before your team starts running eligibility checks. This way, every NPI is available from day one and reduces the chance of errors from manual entry.

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Network Status on VOBs

Upcoming: this applies once the backend release containing PR #1596 is promoted.
When Solum writes an eligibility check into a verification of benefits (VOB) that has no network status yet, the VOB takes one from the credentialing record of the NPI it bills under and the policy’s insurance:
  • In network when the insurance is linked to the NPI with the status Active. A link limited to Plan types or In-network plans counts only for a policy of one of those plan types or plans (the plan is the insurance name the policy shows); when the policy’s plan type isn’t known, a link limited to plan types doesn’t count.
  • Out of network when the insurance is linked with the status Out Of Network and the link isn’t limited to plan types or plans.
  • In network when the insurance isn’t linked to the NPI at all, but the policy’s plan type is one of the NPI’s In-network with all plans of these types. A link to the insurance is an exception to this rule, whatever its status.
A link counts only when the eligibility check’s date of service falls within its effective and end dates. When a VOB’s specialties bill under different NPIs, the network status is set only if all of those NPIs give the same answer. Otherwise the network status stays empty, for example when the insurance isn’t linked and its plan type isn’t one of the NPI’s, or when the link is Pending or Terminated. Solum doesn’t assume out of network. A network status already on the VOB, such as one confirmed with the payer on a call, is never replaced.
Keep each NPI’s linked insurances current so your VOBs show the right network status.

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Permissions

Only Admins can create, edit, and delete credentialing records. Regular users can view credentialing records and use them in eligibility checks, but cannot make changes.

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Troubleshooting