In your situation, it sounds like the employer of the lcsw is the Group. If your setup meets the CMS definition of "Group", then your Group is the participating provider in CIGNA and United Health Care - not the individual practitioners.
Your lcsw would do the work, and a bill would be submitted to either CIGNA or UHC with the Group's Type 2 NPI (who gets paid) and the lcsw's Type 1 NPI (who did the work). Because the charges are being billed in the name of the Group, and the insurance carriers would recognize that the Group is a participating provider, the charges would be paid at the contracted rate. This is the required configuration for billing unless your lcsw is authorized to bill under her own name. But, if your lcsw is being paid for her work by your group, she is not allowed to bill under her own name even if she is authorized to. Billing under her own name would cause payment to go directly to her, and not to your Group. And if your Group is paying the lcsw for her work ... and she gets the money from the insurance carrier instead of your Group getting it .
Your statement about credentialing requirements are correct for members of a CMS-defined group, where the legal entity of the Group name is who gets paid from the carriers. (And as you said, the carriers must have a list of all members who belong to the Group; new members must be added to that list before the carrier will pay the Group for the new member's work.) But, so far as I understand it, those credentialing requirements do not extend to employees or subcontractors of the Group. As I stated above - if a Nurse Practitioner is authorized to bill in their own name, they can - but they will be paid less than if they bill in the name of their employer. Two situations: if they bill in their own name, the Type 2 (who gets paid) and Type 1 (who did the work) NPI numbers must belong to the Nurse Practitioner. Payment goes directly to the NP, but at a reduced rate; if they bill in the name of their employer, the Type 2 (who gets paid) NPI number must be that of their employer, and the Type 1 (who did the work) NPI number must be their own. I know this setup applies to Nurse Practitioners. I do not know if it also applies to Healthy's lcsw.
Doctor was solo practioner and has a group NPI and has proffesional corporation(PC).Recently he start hiring APRN and LCSW and LPC's. all of them work part time for fee for service, they get paid by Doctor according to agreement they made. When they see patient they get paid for that.No other benefits are provided to them as they work few evenings.I am not sure about credentialing process, how it is set up at carrier level.All I know is that they are credential with some carriers and rest like Cigna and UHC has closed their network for LPC's and LCSW's in my area.I am billing for their services under group NPI and use their NPI as rendering provider, no modifier is used and no supervising physician's NPI is used.Now my concern is that how I can bill their services to the carrier who have closed their network for them?I hope this will clear my case and I will get right advice.If still its not clear , please let me know.
Please answer me.
PMRNC, I don't know why you assumed that I am asking you a legal aspect of entity, all I asked was how to bill?
Also I did not force you to answer my question, it was a humble request to all members of forum that "please answer me".it does not say that urgent answer is requested.