Starting a Medical Billing Business > Starting Your Own Medical Billing Business

CAQH

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laceyx08:
what if they are in the application process, like with blue cross blue shield. can they still submit as out of network and get reimbursed for out of network fees, or will they just get denied altogether?

QueenAlicia:
I have been credentialing/re-credentialing/ updating information my provider for and I have had to call EVERY carrier/network.  Each one is different and I mention CAQH to everyone carrier and some don't bother researching it.  Some just want updated documents. 

I think credentialing should be taught in the medical billing courses because this is something that I knew nothing of after graduating 2 medical billing courses.

Michele:
Each carrier is different.  Also, each plan within the carrier is different.  Some will have out of network benefits and will pay, some won't.

PMRNC:
Michele is correct and because each carrier is different there is really no way to teach such a course or service. Credentialing is more tedious and it just requires contacting all the carriers and making sure all their requirements are met.  Where the really hard stuff comes in is phase 2 which many provider's forgo due to the expense, and that's fee schedule negotiations and contract negotiations and reviews. These services require a good amount of experience and an attorney for the provider or someone well versed in contract review. 

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