Author Topic: Credential question  (Read 3962 times)

illenet2

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Credential question
« on: April 01, 2010, 03:33:09 PM »
I am currently doing credentialing for a Physical Therapy Practice that has done only workers comp. cases. They now want to sign up the Physical Therapy Clinic with private insurance companies. The problem is they only want the PT Clinic itself to be credentialed & not the Doctor. I have never done it that way, so I am unsure whether this is possible? All the applications I have received from Ins. Co. seem to want a provider/doctor's name. Can I just use the head Physical Therapist or must I use the doctor? In other words, can I just credential the clinic only & if so, how do I proceed? Thank you, illenet2

Sportsmom

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Re: Credential question
« Reply #1 on: April 04, 2010, 05:38:38 PM »
You would need to check with insurances, some may credential only with a doctor and others will credential each PT.  You are not credential under the group then you will need to credential each one and thats a lot more paper work for you.

When I credential I do it for LPC, LCSW and LMFT the insurnces will not always credential the LPC and LMFT because we do not have doctor to review there charts, but they tell me that up front if I ask other wise I do all the paper work and then they sen dme a letter so I always ask first now.


Michele

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Re: Credential question
« Reply #2 on: April 04, 2010, 08:41:06 PM »
Most insurance carriers require that a group has at least one (some times more than one) provider when they credential a group.  I'm not sure if they will allow you to credential just the group. I also am not sure why the provider wants you to do it that way but good luck.

Michele
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PMRNC

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Re: Credential question
« Reply #3 on: April 05, 2010, 07:38:46 AM »
I concur, usually if you are credentialing a group, each one must be credentialed, they are not just going to assume blind faith for each provider.
Linda Walker
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illenet2

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Re: Credential question
« Reply #4 on: April 05, 2010, 09:38:53 AM »
Thanks guys, your information verified what I believed as well. I need to do some more Insurance calling. illenet2

lgentle

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Re: Credential question
« Reply #5 on: May 05, 2010, 04:31:54 PM »
I am real new at this and I would like someone please tell me what Credential is? Is it some type of insurance the need and where do you find the application?
Thank you, lgentle

PMRNC

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Re: Credential question
« Reply #6 on: May 05, 2010, 05:09:55 PM »
It's the process a provider/group goes through to join a health plan for participation status.
Linda Walker
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lgentle

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Re: Credential question
« Reply #7 on: May 05, 2010, 06:39:04 PM »
Is this something I need to be filing or does the provider? If I need to fill this out where do I get the forms? lgentle

PMRNC

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Re: Credential question
« Reply #8 on: May 06, 2010, 10:29:15 AM »
It's NOT a one form type of thing. Each carrier has their own method of credentialing. If you are doing billing for a client who has existing contracts you should familiarize yourself with them, however I would not undertake the services of credentialing if you do not have experience. There is a process to credentialing and it should not be done unless you know what you are doing. It is the full process (with each carrier) of "credentialing" onto their panel. Contracts, fee schedules, etc are factored into the process.
Linda Walker
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KimGailey

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Re: Credential question
« Reply #9 on: May 11, 2010, 04:00:33 PM »
I found a great website to do credentialing at www.caqh.org

My question is, does a Dr have to complete credentialing with the insurance company to file a claim with them?  If they don't do the credentialing, wouldn't it just be out of network?

ste

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Re: Credential question
« Reply #10 on: May 11, 2010, 07:13:13 PM »
I can relate about completing an application and thinking every possible question could have been asked and the insurance or network organization has been thoroughly researched and few weeks after submitting the application the physician gets a brief postcard in the mail saying "we don't credential naturopaths". One does quickly learn to ask the right questions.

Pay_My_Claims

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Re: Credential question
« Reply #11 on: May 11, 2010, 08:41:05 PM »
I found a great website to do credentialing at www.caqh.org

My question is, does a Dr have to complete credentialing with the insurance company to file a claim with them?  If they don't do the credentialing, wouldn't it just be out of network?

physicians have to be invited into CaQh

Michele

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Re: Credential question
« Reply #12 on: May 12, 2010, 07:27:35 AM »
CAQH isn't really a website to 'do credentialing'.  It is an online universal credentialing application that many insurance carriers utilize to reduce the paperwork required to credential a provider.  Charlene is correct, CAQH is not something a provider can sign up for.  CAQH numbers are only issued by insurance carriers.  CAQH cannot (well they can but they won't) assign CAQH provider numbers to a provider.  CAQH is a wonderful tool, but it doesn't replace credentialing, it just assists.  Each insurance carrier must still be contacted and most still have additional paperwork that must be completed in addition to the CAQH.

Michele
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DMK

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Re: Credential question
« Reply #13 on: May 12, 2010, 11:20:09 AM »
I'm a little concerned about some of the questions being asked.  It seems like there are some billers out there who are in WAY over their heads.  It makes me wonder if offices are hiring completely inexperienced employees and making them "figure it out".  Hmmmmm.

PMRNC

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Re: Credential question
« Reply #14 on: May 13, 2010, 06:27:11 AM »
 ::)
Linda Walker
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