Billing > Billing

Non-credentialed providers

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Wondering:
New physician joins the practice and is in the process of being credentialed by a payor. The new physician sees patients with this payors insurance. Can the claims be filed under one of the other providers until this physician is credentialed ?

PMRNC:
No

Wondering:
Thank you. Had it suggested and it did not seem like the right thing to do. Would you consider that fraudulent billing?

PMRNC:

--- Quote ---Thank you. Had it suggested and it did not seem like the right thing to do. Would you consider that fraudulent billing?
--- End quote ---

Yes, it would be not only for the provider but whomever billing it as well since it's reporting a provider providing services that did not provide services. If the patient has not been seen it's best to disclose to the patient that physician is not yet in-network and see if another provider in practice can see them or have them pay their out of pocket and bill it and it will be paid as non-par.   If you are the one doing the billing.. don't bill out anything you know or suspect to be wrong, it's your neck on the line as well.

Angie:
What if they are in the process of getting their license and are being supervised by the Ph.D.; Can they bill it under the Ph.D. since he is the supervising?

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