Document Checklist

IRS Form W-9 (Request for Taxpayer Identification Number). Must be signed and dated within the last 12 months.

Download the current W-9 from IRS.gov. Use your legal name and EIN or SSN as it appears on your tax return.

A clear copy of your current, active state professional license (LCSW, LPC, LMFT, PhD, PsyD, or equivalent).

Ensure the license is not expired. If renewal is pending, provide proof of renewal application.

A voided check from your practice bank account, or an official bank letter confirming your routing and account numbers.

Write "VOID" clearly across the check in ink. Alternatively, a bank-issued letter on letterhead is accepted.

Your Type 1 (individual) NPI number. If you have a Type 2 (organizational) NPI, include that as well.

You can look up or confirm your NPI at nppes.cms.hhs.gov. Include both Type 1 and Type 2 if applicable.

Copies of any insurance credentialing approval letters or certificates you have on file.

Helpful if you are already paneled with insurers. Speeds up verification and avoids duplicate credentialing requests.

A recent Electronic Remittance Advice (ERA) or Explanation of Benefits (EOB) from any payer.

Redact patient names and identifiers before sending. This helps us understand your current payer mix and payment patterns.

Login credentials or an invitation to your EHR or practice management system (e.g., SimplePractice, TherapyNotes, Jane).

Create a separate staff or billing user account for Good Rack LLC rather than sharing your personal login.

Access credentials or invitations to any insurance payer portals you currently use (Availity, Optum, etc.).

If you have existing portal accounts, adding Good Rack LLC as a delegate is faster than re-registering.