Author Topic: Out of State Billing-- Insurance Participation  (Read 491 times)


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Out of State Billing-- Insurance Participation
« on: April 04, 2022, 07:44:44 PM »
I bill for a psychiatrist who's practice is located in Pennsylvania. He participates with BCBS (Highmark) in Pennsylvania. He has a patient who is moving to North Carolina and will have a BCBS plan there. The provider is in the process of getting licensed in NC so that he can continue care for the patient via telehealth.  When we bill BCBS out of area plans currently, the patients are in Pa, and we always bill to our local BCBS. I'm not sure that will be the process once he is licensed in NC and the patient is physically located in NC during the visits.

Once he obtains the license, will he need to credential with BCBS North Carolina?

Can a provider who's practice is in another state participate (in network) with a North Carolina plan?

Will the claims still go to the local BCBS, or directly to BCBS NC?

Sorry for all of the questions. I've been a medical biller for over a decade, but have never had a provider licensed out of state or in multiple states.
« Last Edit: April 04, 2022, 07:47:24 PM by PaBilling2022 »


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Re: Out of State Billing-- Insurance Participation
« Reply #1 on: April 13, 2022, 10:37:12 AM »
If he does not have a physical practice location in NC, I believe he would need to bill his local (PA) BCBS.  They implemented new POS code 10 to indicate that the patient is in their home, and the patient's address is on the claim.  But the provider is still in PA, and he is in network with his local BCBS, all claims will go there.  But I would contact his local BCBS to verify.
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