Author Topic: Credentialling  (Read 1133 times)

MFunk

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Credentialling
« on: November 27, 2015, 11:40:58 AM »
Hello, I have a client that is a halfway house that bills for IOP, & OP. They do not have a medical doctor on staff yet; no a NP, PA or licensed social worker. They basically have certified counselors which medicaid and medicaid won't enroll. The group is enrolled with Medicaid but not Medicare or any other insurance company commercial. In the past they asked me to see about getting them participating but because they did not have a provider I was shut down.  Now they have went through a huge process to become accredited with CARF. http://www.carf.org/home/  Personally I had never heard of CARF before. But my office seems to think this is the magic bullet and now all insurances will accept them. I don't know what to do with this. Does anyone know how I might get these folks some insurances to bill & pay for their much needed services? Anyone else know of CARF or why my office thinks they are the magic bullet. I really hope they are because they went through it to get it.

PMRNC

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Re: Credentialling
« Reply #1 on: November 28, 2015, 10:24:47 AM »
They can go through any type of accreditation  they want, the fact of the matter as you wrote:
Quote
They do not have a medical doctor on staff yet; no a NP, PA or licensed social worker. They basically have certified counselors which medicaid and medicaid won't enroll
Still stands.

What services are they even looking to be covered?  Having their facility accredited won't change the fact that they are not utilizing the services of an approved/licensed provider and insurance carriers are not going to reimburse services by a non provider not recognized, nothing will change that with them getting accredited. You have to look at services being rendered, and by what type of provider.
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Michele

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Re: Credentialling
« Reply #2 on: November 28, 2015, 08:19:25 PM »
I have never heard of CARF.  But I found their website:  http://www.carf.org/Providers/ 

It says on their site that they are recognized by many major carriers but you won't know for sure until you actually contact them.  I don't think it will make any difference with Medicare though. 

  Having their facility accredited won't change the fact that they are not utilizing the services of an approved/licensed provider and insurance carriers are not going to reimburse services by a non provider not recognized, nothing will change that with them getting accredited. You have to look at services being rendered, and by what type of provider.

I think Linda is right here.  Personally I don't think that the CARF will change anything without the licensed provider on staff.
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MFunk

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Re: Credentialling
« Reply #3 on: November 29, 2015, 06:29:45 AM »
Thanks. I was afraid you say that. I keep having to be the barer of bad news with these guys.
What there are providing ins intensive outpatient therapy, outpatient therapy, individual outpatient therapy, and intake assessment. I can't think of the CPT codes off hand but the HCPC codes are H0015, H0005, H0004, and H0001