Medicaid Toolkit

Credentialing 

State Medicaid agencies set rules specifying the qualifications for providing audiology and speech-language pathology billable services. These rules can vary depending upon the setting. Best practice standards recommend that states require that audiologists and speech-language pathologists meet the requirements stated in the Federal Register, Title 42, addressing the Certificate of Clinical Competence (CCC), Clinical Fellowship (CF), and/or state licensure. Each state plan outlines the use of National Provider Identifier (NPI) numbers by those billing Medicaid. Although some states may require providers to obtain and use their individual NPI numbers when billing for services rendered, other states allow providers to bill under the facility (e.g., school district or facility) identifier. Professionals should consult with state and local administration to determine if an individual NPI number is required.

Considerations

  • Determine whether different requirements apply to different practice settings in the state.
  • Determine whether an NPI number is needed.
  • Determine if there are any ongoing requirements to maintain credentials.

Advocacy

Advocate for CFs to become Medicaid providers in all settings to ensure that

  • there will be an adequate number of providers, and
  • the state can meet the need for additional providers that may result from Medicaid expansion or general increase in Medicaid roles.

Resources

ASHA Corporate Partners