Author Topic: Billing for noncredentialed providers  (Read 1447 times)


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Billing for noncredentialed providers
« on: May 31, 2015, 01:37:10 PM »
I am curious to know if a provider is in the process of being credentialed and it is taking a very long time are we able to bill under our group NPI and or another provider NPI as long as everything is being supervised by the credentialed provider?


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Re: Billing for noncredentialed providers
« Reply #1 on: June 01, 2015, 03:04:31 AM »
It depends on what type of provider is being credentialed. If it is a NP or a PA, yes we may bill claims under the name of a Credentialed provider (if the credentialed provider would be supervising the services). But, I don't think an MD can be  supervised by another MD and therefore that restricts MD's from billing under a different MD's name which might also turn out to be fraudulent.

On the other hand, your question about billing under the Group NPI... The bills may go out with Group NPI under Block 33 of the CMS 1500 form. But the rendering provider NPI has to be that of an individual.


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Re: Billing for noncredentialed providers
« Reply #2 on: June 01, 2015, 03:22:12 PM »
California here.  One of our MD clients left his practice to go work for a Concierge Medicine outfit.  He hired an MD from the midwest to take over his practice.  When the midwest MD gets fully credentialed in California, he will then purchase the practice.

Right now, midwest MD is seeing the patients and is being paid a salary for doing so.  We bill with the current owner's Type 2 NPI Number in Box 33(a) and the midwest MD's Type 1 NPI Number in Box 24(j).  We are getting paid, including from Medicare.  Your state law may vary.