Author Topic: enrollment with insurance  (Read 2397 times)

Jodipt25

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enrollment with insurance
« on: May 16, 2012, 07:42:54 PM »
I apologize in advance for this very "grassroots" question...
Could somebody PLEASE clear up for me the difference between capital blue cross, blue cross blue shield, highmark/freedom  blue, etc..  I am in the process of enrolling our new PT practice and am confused: if I enroll with capital blue cross, who exactly am I covered to bill? which plans must I enroll in seperately?
I have started the process of enrolling with Medicare, and have called others for an application, but just want to make sure I have covered all of my bases and the names are very confusing, they all sound similar but do they require seperate enrollment.  Thanks. 

DMK

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Re: enrollment with insurance
« Reply #1 on: May 16, 2012, 08:14:06 PM »
In GENERAL, you need to sign up with Blue Cross and Blue Shield.  Those enrollments will trickle through all the manifestations of the Blue Cross/Blue Shield programs.  Also enroll with Medicare, United HealthCare, and CIGNA.  There will be others, depending on your specialty, but these major plans encompass most insurance coverage.

PMRNC

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Re: enrollment with insurance
« Reply #2 on: May 16, 2012, 08:28:43 PM »
Also BC is hospitalization while Blue shield is major medical. The exception is California I believe.   Each BCBS will have a 3 letter alpha numeric prefix. Go to your state's BCBS website and they should give you a listing of those groups as it will help you determine where to bill. If you sign up with your local BCBS but see an out of state BCBS patient you still will bill your local BCBS and there will be a different claims address for out of state plans.  All of the above is cancelled out for Mental health. MOST BCBS plan's utilize a TPA for mental health so if you are billing for a mental health provider and you credential with BCBS you will also want to credential with the TPA's for each plan.   NOT all BCBS groups use the TPA, but most do for mental health claims.   Also BCBS is one of the only carriers who do NOT have to honor assignment for non par providers, so even if you have a patient who assigns benefits but your provider is non par, the check will be sent to the patient. VERY Important to know.   
Linda Walker
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Re: enrollment with insurance
« Reply #2 on: May 16, 2012, 08:28:43 PM »