Participating Providers

[Medicare56]

What must be done in order to participate with an insurance carrier or type of insurance? How is this similar to (or not) to being in or out of network with an insurance?

[RichardP]

Google on "provider relations" + "name of insurance company" .  You will get a page similar to the first link below.  Notice on the left side, under the "Providers" heading, about 3rd link down is a link for Credentialing.  Click on that link to get a page similar to the second link below.  Read the page at that second link below.  It should answer many of your questions.

Each state regulates the health insurance companies it allows to sell insuance in that state.  So you need to find out the insurance requirements for your state.  You should be able to find a web page, for a given insurance carrier, for your state.

http://www.bcbsla.com/Providers/Pages/ForProviders.aspx

http://www.bcbsla.com/Providers/Credentialing/Pages/default.aspx

[Medicare56]

Thanks alot! We recently had a situation where we billed Gateway Medicare insurance as a secondary like Medicaid, but we were denied because Gateway was not yet sold yet in our area as a Medicaid, only Medicare. So we couldn't do anything about it. I thought it was the strangest thing. They kept saying "it's not a Medicaid, only like a Medicare" and I couldn't understand what they meant, but then my manager explained that we weren't a participant and couldn't be anyway.

[RichardP]

We recently had a situation where we billed Gateway Medicare insurance as a secondary ... but we were denied because Gateway was not yet sold yet in our area ...

Could you please clarify that statement.  It seems to me that either your patient(s) had Gateway as a secondary or they didn't.  If your patient(s) did have Gateway as a secondary, Gateway should have paid or denied the claim for legitimate reasons (such as, your provider is not in their network and they offer no out-of-network benefits).  If your patient(s) did not have Gateway as a secondary, you would not be billing them.  I don't understand what not yet sold in our area has to do with anything.