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Third Party Billing Application

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AKA:
Help! I'm located in NJ and currently applying for a third party billing service with the state. I will start off as a sole proprietor and doing business at my home office. One of the documents needed is "a copy of the executed bylaws, operating agreement, rules and regulations, or other document relating to the operation of the applicant's internal affairs." Called the person who I will be sending this application to and asked if it's required for a sole proprietor and he said yes. So now, where can I get a sample of this for a sole proprietor? Most of the stuff I'm finding are for corporations and have several members.

PMRNC:
I'm from NJ and familar with their registration process... let me first say that make sure every i is dotted and t is crossed because they WILL send it back and hold you up..they scrutinize every application! 

I'm a sole propietor but I'm an LLC for me i would send them my bylaws and P&P.

--- Quote ---other document relating to the operation of the applicant's internal affairs.
--- End quote ---
  For you as just sole propietor, not incoroporated or as LLC this would just be your operations manual or policies and procedures you do internally.

I have NJ PMRNC members who have told me they received 3 and 4 rejections for very small things. MAKE sure you send them EVERYTHING they require! Last time I saw the form they had 15 items on there. TAKE particular note to follow the law for the contract.. I think they provide you with the link for the provision. Also where it says to submit the means in which you will receive compensation..think twice about % if you plan to bill a % as they will reject it because of Medicaid law in NJ (fee-splitting provisions) I never reccomend a % anymore but if you are going to do it make sure your contract has a clause to provide compensation method for Medicaid. I've had billers get rejected for it. Cover yourself and have attorney review it for you first.

Another common rejection is that people submitting the application don't realize that what NJ calls a quality assurance procedures (or something similar) is actually your compliance plan.  And when they send you a rejection it's just check boxes and they don't give you details on what you were missing and in fact they will tell you they expect you to know..PAIN in the rear end...I don't have anymore NJ clients but in general it's a great way for billing companies to establish credibility in a very saturated market. NJ is full of billing companies who don't bother to register or don't know. When I get a NJ member, before I list them In our listing area, I make sure they are registered first.

AKA:
Wow thank you for this and for letting me know about the % part. I have it written on my business plan that compensation will be on a %. What do you suggest for me to put down for providers who take Medicaid? Also do you know how long it takes to get a response once I send my application?

Again, thank you for this. This is very informative! =)

PMRNC:
I would work up either a flat fee for Medicaid or per claim/per service..but you want to make sure that is fully disclosed in your contract.

As for turn around I've heard 2 weeks is about average..but if it's a rejection they can hold you up another 30 days.

AKA:
Hi Linda,

Thank you again for the heads up with the third party application. I sent my application in yesterday and already got a response this morning! Like you said, they do look at EVERY single thing. I didn't put my middle name in one of the applications and I have to correct it. Grrrr. One of the things I was told that was missing was  in my standard contract it should include the responsibilities of the third party billing service to the provider with respect to maintenance of back-up systems against loss of records AND responsibilities of the third party billing service with the client with respect to maintenance of insurance coverage by the third party billing service against risk of loss. They also did state that the third party billing service does not have to provide any of these but the contract must make it clear whether or not the third party billing service is providing these items to its client. Are you familiar with this and what would you suggest I put on my contract? And would this be under the BAA? Do most medical billing services provide these to their clients?

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