here is the results of my research-
I contacted the LPC board in NC and received this response in the email below- it reminds us that the counselors, any counselor seeing a client, needs to be registered with the insurance company. Now if they are registered but not contracted they are an out of network provider (regardless of you contract status).
So for each of the insurance companies that the associate is wanting to send claims to you need to contact the insurance company about the process of the associate becoming either credentialed to become an in network provider or be registered with the insurance company so the out of network claims will be recognized and processed.
Contracting, if the panels are open, can take 4 to 6 months. Registering as an out of network provider can take 30 to 45 days.
Now the second thought is finding out if the insurance company itself, in this case BCBS and UBH, are allowing associates to see client's. I have called BCBS of NC and UBH for NC and they have not yet returned my calls.
I checked on the Optum/UBH website and they are not accepting new providers in your county. The roster is full. So the associates will have to file as out of network providers. I called Network Management and they have added Tina Tuttle to the system. So she is set to send claims now to UBH/Optum.
BCBS of NC website says it does accept applications for LPCA. Which is good. However, it does not say whether or not the panel is open now or if the area is saturated and not accepting new providers. It invites providers to apply without any indication that the application will be accepted as an in network provider.
HOWEVER, it does specifically say that -Claim payments are only made directly to you if you have an active BCBSNC contract. Meaning, perhaps, that out of network claims will pay the client and not the provider.
Associates will need to be on the CAQH website. I assume you are also registered on that website so you know what I am talking about. So that is the first question, is Tina on CAQH?
The BCBS of NC website page for getting started on the credentialing process is here-
http://www.bcbsnc.com/content/providers/application/instructions.htm As you add insurance companies to the associates for billing I will check on those insurance companies separately.
And benefits and filing are not a guarantee of payment. Claims are not guaranteed until the are processed. So just because UBH/Optum added Tina it may be the individuals insurance plan that dictates whether the claim is payable under that type of provider. And it may be that BCBS of NC will send claims payments for out of network providers to the patient.
