Medical Billing Forum
Starting a Medical Billing Business => Starting Your Own Medical Billing Business => : TammyL June 27, 2011, 09:17:22 PM
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Okay I have a new provider who is a MA, LPC and she wants to get credentialed with other insurance companies besides medicaid she' on the caqh so how do i go about getting her on more panels would it be thru insurance companies or thru the caqh.
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You have to contact each insurance carrier individually and see if they are accepting new providers in her area and if they credential MA, LPC's. Having the CAQH already done is helpful.
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That's what I thought just wanted a second opinion
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I'm confused on how they get the provider ID to fill out the application. The website talks about the CAQH provider ID that was sent to you, I don't know how they get it.
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CAQH provider ID's are assigned/created by an insurance carrier. CAQH does not issue the numbers to providers. If a provider wants to join the network, or recredential with an insurance carrier that uses CAQH, that carrier will issue the provider a CAQH number. Then the provider can go to the CAQH website and click on "logging in for the first time" to complete the application.
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do they have to fill it out all over again and get a new id number if they are going from a group to a solo practice?
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I was wondering the same thing about credentialing. I have a provider who wants to go from cash only to billing to the insurance. He says he has a caqh universal provider number.
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You just have to update his CAQH to reflect the current information.
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do i have to contact the insurance companies to tell them it was updated or can she just bill to them?
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Each insurance carrier has to be contacted if the provider plans on being "in network". If they plan on being out of network, they can just bill.
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what if they are in the application process, like with blue cross blue shield. can they still submit as out of network and get reimbursed for out of network fees, or will they just get denied altogether?
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I have been credentialing/re-credentialing/ updating information my provider for and I have had to call EVERY carrier/network. Each one is different and I mention CAQH to everyone carrier and some don't bother researching it. Some just want updated documents.
I think credentialing should be taught in the medical billing courses because this is something that I knew nothing of after graduating 2 medical billing courses.
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Each carrier is different. Also, each plan within the carrier is different. Some will have out of network benefits and will pay, some won't.
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Michele is correct and because each carrier is different there is really no way to teach such a course or service. Credentialing is more tedious and it just requires contacting all the carriers and making sure all their requirements are met. Where the really hard stuff comes in is phase 2 which many provider's forgo due to the expense, and that's fee schedule negotiations and contract negotiations and reviews. These services require a good amount of experience and an attorney for the provider or someone well versed in contract review.