Author Topic: Do I need to file for a Third Party Administrator license?  (Read 4905 times)

Cmporter82

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Do I need to file for a Third Party Administrator license?
« on: August 01, 2012, 12:27:46 PM »
I am trying to get my billing business off the ground and I looking at my state's website (Michigan) for Medical Claims it says I need to file a Third Party Administrator License with the State.  This seems to me like its more for an insurance company as it says to "Process claims".

Is anyone else familiar with this?  I called the number it listed to find out and they were pretty clueless! 

Thank you so much!

Michele

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Re: Do I need to file for a Third Party Administrator license?
« Reply #1 on: August 05, 2012, 07:09:02 AM »
It sounds like Michigan may require Medical Billing Services to have a license.  Some states do.  I am not familiar with Michigan.  Is there a number you can call to ask for clarification?
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PMRNC

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Re: Do I need to file for a Third Party Administrator license?
« Reply #2 on: August 06, 2012, 10:03:42 AM »
I would actually call them to be sure because the word "processes" can mean any process involving medical claims, their number is right on this page: http://www.michigan.gov/lara/0,4601,7-154-35299_10555---,00.html
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Cmporter82

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Re: Do I need to file for a Third Party Administrator license?
« Reply #3 on: August 06, 2012, 10:17:58 AM »
Thanks for the info! 

Kind of funny but I called and they were clueless!  I spoke to about 4 people who had no idea what I was talking about.  Told me I didn't have to fill it out, etc. I did some more research and I DO in fact need to file this paper.

I am discovering this is quite a process!   

PMRNC

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Re: Do I need to file for a Third Party Administrator license?
« Reply #4 on: August 06, 2012, 11:37:16 AM »
NJ has filing and reporting reg's for third party billing companies too. It's actually a process and you even have to have your contract approved with your application.
Linda Walker
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Cmporter82

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Re: Do I need to file for a Third Party Administrator license?
« Reply #5 on: August 06, 2012, 11:47:37 AM »
Yes, my contract must be included in my application as well.  I have emailed a few lawyers regarding this, anxiously awaiting their responses!  I am waiting for my city license to be approved (which they told me could be a month) before I can send it in as well. 

galley

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Re: Do I need to file for a Third Party Administrator license?
« Reply #6 on: August 08, 2012, 08:15:39 PM »
I was just certified by the NJ Department of Insurance and Banking a couple of month ago.  Third Party Administrator are companies that receive monies directly from the insurance companies as payment for services.  They will explain that to you.  Third party billing services is what I believe you are speaking of.  Billing on behalf of a healthcare provider.  Yes, you must submit application, business plan and contract.  You do not have to have a contract with a provider at the time of filing, but they want to see what type of contract you will be using.  The business plan must be submitted in a binder by their specifications.  I am doing business from my home and my county doesn't require me to have a license unless I have traffic in and out of my home.  NJ department of Insurance and Banking require you to have documentation from Department of Treasury, division of Revenue for the formation of company which specifies your entity name. I have also checked with several other states about doing business and their only requirement is license for TPA (third party administrator license).

PMRNC

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Re: Do I need to file for a Third Party Administrator license?
« Reply #7 on: August 09, 2012, 08:46:15 AM »
Gallery is correct about NJ, The term licensing and registration are two different things. But from what Cmporter82 it looks like her state too does require the same things, more states are adding this which I think in the long run is GREAT for us as it gives our industry yet some more professionalism!  How many of those home study or biz opportunity packages teach you that you need a compliance plan? Soon that will be required and every Third party billing company should have one in place! Requiring licenses and/or registrations is the first step in a great process I hope continues.   It's going to force training and educational companies to step up their training or go out of business and it's going to weed out the billers with a false sense of what this business is about. On the average I speak to hundreds of new billers a month but sadly only 5-10% will make it.
Linda Walker
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Cmporter82

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Re: Do I need to file for a Third Party Administrator license?
« Reply #8 on: August 09, 2012, 09:14:32 AM »
Even though it seems like a hassle right now, I am glad that they do enforce such things. 

I cannot believe the number of people that do not even know what a compliance plan is (sad, but true). 

It kind of makes me laugh a little when I hear people talk about wanting to start an at home business and they think that Medical Billing will be "easy".  Especially those people who don't even have any experience.  I LOVE medical billing, and I wouldn't call it easy.  That's part of the reason I love it!  It keeps me on my toes and busy.  It's very detailed oriented.  You HAVE to be on top of things, you HAVE to be organized.  You HAVE to keep up to date with your education.  You have HAVE to know the laws.  You HAVE to be compliant.  You HAVE to know what you're doing.  I think people who just try to walk into medical billing completely ignorant are going to find themselves in quite a bind. 

DMK

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Re: Do I need to file for a Third Party Administrator license?
« Reply #9 on: August 09, 2012, 10:56:20 AM »
I LOVE that you realize the HAVE TO items!  That indicates that you are moral, ethical, and legally compliant!  When you include the HAVE TO items in your sales presentation it will make the Doctors more confident in you!

PMRNC

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Re: Do I need to file for a Third Party Administrator license?
« Reply #10 on: August 09, 2012, 11:25:25 AM »
When I run into a practice that is shopping or they have another billing company in mind, I ask them if they have seen the billing company's compliance plan and I'm guaranteed to win the account. It blows my mind how these companies (even the more experienced ones) do NOT have one.  When providers go to the conventions they are being told if they are going to outsource that is one of the things to make sure the outsourced company has! 
Linda Walker
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HBCreview

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Re: Do I need to file for a Third Party Administrator license?
« Reply #11 on: September 05, 2012, 01:48:09 PM »
this is for PMRNC. What is a Compliance Plan. My partner and I are starting our Medical Billing Company in Michigan and would like some friendly insight on a Compliance Plan

PMRNC

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Re: Do I need to file for a Third Party Administrator license?
« Reply #12 on: September 05, 2012, 07:40:28 PM »
Quote
this is for PMRNC. What is a Compliance Plan. My partner and I are starting our Medical Billing Company in Michigan and would like some friendly insight on a Compliance Plan

Unfortunately it's the one thing most courses/classes/home study programs do not teach you about and it's also the MOST important thing next to your contracts. Basically a compliance plan is a plan on how your company meets all compliance rules/regs, and procedures taken if there is a breach. You will want to look at the OIG's Proposed guidelines for third party medical billing companies. http://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf
 Mine is a a very large 5'' binder sectioned and I allow provider's to take it for a few days to look over.

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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157ataylor

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Re: Do I need to file for a Third Party Administrator license?
« Reply #13 on: October 15, 2012, 08:00:08 PM »
in nyc we need to have a license?

Michele

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Re: Do I need to file for a Third Party Administrator license?
« Reply #14 on: October 16, 2012, 07:41:16 PM »
For what?  As a Billing Service?
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