NON CREDENTIALED PROVIDER

[Cjena6486]

Hello. I am working with a provider and we are making our way through the credentialing process. He saw a BCBS patient however we are not credentialed with them yet. Am I still to bill the claim and if so, will this then be patient responsibility after it denies? This is a non-profit practice.

[medwave]

You can try to bill for it, but the probability of it being paid out is slim and it will be denied. Doesn't matter if it's non-profit or not, the patient is going to be held responsible.

[Cjena6486]

Thanks!

[Michele]

It really depends on your BCBS.  Do they backdate the effective date to when the app started?  Or when the contract is signed?  It can be rebilled, or reprocessed if the effective date ends up being prior to the date of service.

[Cjena6486]

These are great questions. I will definitely call and ask. Thank you for the advice!

[michaelharris99]

There is a very slight chance of getting paid and yes, in the end it will be patients responsibility after the denial of the claim.

[PMRNC]

If it's an HMO you won't get paid. But no one mentioned that they might still pay at OON rate which goes by U&C. Any amount over U&C would be patient responsibility.