Medical Billing Forum
Billing => Billing => : jbbilling October 28, 2015, 04:09:25 PM
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Is anyone familiar with credentialing and billing with BCBS of NY? If a practitioner is credentialed with BCBS as an in network provider and she hires a new provider to work under her group....does the new employee also need to be credentialed with BCBS in order to get paid?
Also, if you are credentialed under your individual NPI and then you decide to create an LLC and get a type 2 NPI...do you need to get re-credentialed as the group or is it just considered a provider update. If the group is in network, does that make all providers working within the group in network?
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What part of NYS? There are different BCBSs depending on which part of the state. For BCBS Utica/watertown you do need to credential each individual provider. Also, if a provider switches from an individual NPI to a group NPI & EIN they just need to contact their provider rep & sign a new contract for the new NPI/EIN.
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Just to add, I have dealt with adding providers to various practices in various states, and I have never seen a situation where a new provider can just come on board and start billing insurances and be considered in-network, just because the provider who owns the practice is in-network. They all have had to become credentialed with the insurance company themselves.
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I do a lot of Anthem BCBS.. each provider in a group must be credentialed. As for the second question on the LLC.. I'm not sure really but here is there provider manual: https://www.empireblue.com/provider/noapplication/f4/s2/t0/pw_e195300.pdf?refer=ehpprovider Credentialing starts at page 128