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(Moderators:
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Can a provider be out of network while working at an in network facility?
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Topic: Can a provider be out of network while working at an in network facility? (Read 1736 times)
richw
Newbie
Posts: 6
Can a provider be out of network while working at an in network facility?
«
on:
July 04, 2019, 02:12:35 PM »
Happy 4th of July!
I am working at a clinic that is looking to go in network with Aetna. I was told I cannot stay out of network with Aetna if the clinic contracts with Aetna because claims are billed under the clinic's NPI. Is there a way around this? Or do I have to contract with Aetna too?
Thanks
Rich
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Michele
Administrator
Hero Member
Posts: 5927
Re: Can a provider be out of network while working at an in network facility?
«
Reply #1 on:
July 05, 2019, 01:39:12 PM »
I'm not sure that you have to contract with Aetna individually however they may process claims as in network when you are the rendering provider if they are going by the group information. Who is telling you this information? I would check directly with Aetna to ask how it works if the group you are working under is in network but you individually are not.
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richw
Newbie
Posts: 6
Re: Can a provider be out of network while working at an in network facility?
«
Reply #2 on:
July 06, 2019, 12:00:43 AM »
Thanks Michelle,
My employer was giving me this information. I would think I could still stay out of network and just have them bill my claims under my individual npi. I will have to call Aetna. Thank you!
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PMRNC
Hero Member
Posts: 4562
Re: Can a provider be out of network while working at an in network facility?
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Reply #3 on:
July 06, 2019, 10:09:03 AM »
You wouldn't be able to see Aetna patients.
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Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com
richw
Newbie
Posts: 6
Re: Can a provider be out of network while working at an in network facility?
«
Reply #4 on:
July 06, 2019, 06:19:11 PM »
@PMRNC, thank you.
Could you elaborate on this?
Rich
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Medical Billing Forum
Re: Can a provider be out of network while working at an in network facility?
«
Reply #4 on:
July 06, 2019, 06:19:11 PM »
richw
Newbie
Posts: 6
Re: Can a provider be out of network while working at an in network facility?
«
Reply #5 on:
July 09, 2019, 02:24:35 AM »
Aetna confirmed that if they cannot split providers in and out of network at the same facility (or at least under the same tax ID)
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PMRNC
Hero Member
Posts: 4562
Re: Can a provider be out of network while working at an in network facility?
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Reply #6 on:
July 09, 2019, 12:08:22 PM »
Correct, would not be fair to patients.
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Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com
Medical Billing Forum
Re: Can a provider be out of network while working at an in network facility?
«
Reply #6 on:
July 09, 2019, 12:08:22 PM »
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Medical Billing Forum
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Can a provider be out of network while working at an in network facility?