Legal Names, DBAs, and Their Impact on Healthcare Insurance Credentialing

Understanding the difference between your legal business name and any “doing business as” (DBA) names is essential for a smooth healthcare insurance credentialing process. Using the correct names on all applications and documents helps prevent delays, denials, and payment issues.

What Is a Legal Name?

The legal name of your business is the official name registered with the IRS and your state’s Secretary of State. This is the name that appears on tax documents, legal contracts, and government filings. For individuals, it’s the name on your government-issued ID; for entities, it’s the name on your formation documents (e.g., “ABC Medical Group, LLC”).

What Is a DBA?

A DBA (“Doing Business As”)—also called an assumed name, trade name, or fictitious name—is any name your business uses to operate that is different from its legal name. For example, if “ABC Medical Group, LLC” operates clinics under the name “Downtown Family Health,” “Downtown Family Health” is a DBA.

• DBA registration is typically required at the state or county level if you use a name other than your legal name.

• Registering a DBA does not provide legal protection for the name, but it allows you to conduct business, open bank accounts, and market under that name.

Why Do Legal Names and DBAs Matter in Credentialing?

Credentialing Applications

• Insurance payers require your legal name (as registered with the IRS) on all credentialing and contracting documents. This ensures your Tax ID (EIN) and business name match IRS records.

• DBAs may be used for branding or patient-facing purposes, but payers need to know the legal entity behind the DBA.

Common Issues

• Mismatched names (e.g., using a DBA instead of the legal name on credentialing forms) can cause delays, denials, or payment holds.

• Incorrect or missing DBA registration may prevent you from using your preferred business name on signage, marketing, or claims.

• Changing your legal name (e.g., after a merger or reorganization) requires updating all payers, credentialing bodies, and government agencies to avoid disruptions.

Claims and Payments

• Claims must be submitted under the legal name and Tax ID that matches your credentialing and payer contracts.

• Payments and 1099s are issued to the legal entity, not the DBA.

Best Practices

• Always use your legal name (as registered with the IRS) on credentialing, contracting, and tax documents.

• List your DBA where requested, especially if it’s the name patients or the public recognize.

• Register your DBA with the appropriate state or county agency before using it in business operations.

• Keep all records consistent—ensure your legal name and DBA are up to date with the IRS, state agencies, payers, and credentialing platforms.

• Notify payers promptly if you change your legal name or add/remove a DBA.

Summary Table: Legal Name vs. DBA

Name Type	Definition	Where Used	Impact on Credentialing
Legal Name	Official name registered with IRS/state	Tax forms, contracts, claims	Must match IRS and payer records
DBA	Alternate name for business operations	Marketing, signage, patient-facing	Must be registered; used for branding

When to Use Each Name

• Credentialing and contracts: Use your legal name.

• Marketing and patient communications: Use your DBA (if registered).

• Claims and payments: Use your legal name and Tax ID.