Medical Billing Forum

Billing => Billing => : KimGailey May 11, 2010, 07:24:51 PM

: Billing for Non-par provider
: KimGailey May 11, 2010, 07:24:51 PM

Does a Dr have to complete credentialing with the insurance company to file a claim with them?  If they don't do the credentialing, wouldn't it just be out of network?

: Re: Billing for Non-par provider
: Pay_My_Claims May 11, 2010, 11:40:13 PM

yes, not credentialed = non par

: Re: Billing for Non-par provider
: Michele May 12, 2010, 10:29:33 AM

Some plans do not have out of network benefits so submitting the claim doesn't always  mean payment will be made.  But you should always file to be sure.

: Re: Billing for Non-par provider
: Priyan May 18, 2010, 09:56:35 AM

For Traditonal insurance like Medicare and Medicaid we cannot send an claim form to them untill we are credentialized