Medical Billing Forum

General Category => General Questions => : richw July 04, 2019, 02:12:35 PM

: Can a provider be out of network while working at an in network facility?
: richw July 04, 2019, 02:12:35 PM

Happy 4th of July!

I am working at a clinic that is looking to go in network with Aetna. I was told I cannot stay out of network with Aetna if the clinic contracts with Aetna because claims are billed under the clinic's NPI. Is there a way around this? Or do I have to contract with Aetna too?

Thanks

Rich

: Re: Can a provider be out of network while working at an in network facility?
: Michele July 05, 2019, 01:39:12 PM

I'm not sure that you have to contract with Aetna individually however they may process claims as in network when you are the rendering provider if they are going by the group information.  Who is telling you this information?  I would check directly with Aetna to ask how it works if the group you are working under is in network but you individually are not.

: Re: Can a provider be out of network while working at an in network facility?
: richw July 06, 2019, 12:00:43 AM

Thanks Michelle,

My employer was giving me this information. I would think I could still stay out of network and just have them bill my claims under my individual npi. I will have to call Aetna. Thank you!

: Re: Can a provider be out of network while working at an in network facility?
: PMRNC July 06, 2019, 10:09:03 AM

You wouldn't be able to see Aetna patients.

: Re: Can a provider be out of network while working at an in network facility?
: richw July 06, 2019, 06:19:11 PM

@PMRNC, thank you.
Could you elaborate on this?
Rich

: Re: Can a provider be out of network while working at an in network facility?
: richw July 09, 2019, 02:24:35 AM

Aetna confirmed that if they cannot split providers in and out of network at the same facility (or at least under the same tax ID)

: Re: Can a provider be out of network while working at an in network facility?
: PMRNC July 09, 2019, 12:08:22 PM

Correct, would not be fair to patients.