Obtaining payer credentials

November 1, 2006

I'm planning on opening a new office. I have only been able to be credentialed by a few insurance companies. How do I go about charging patients on plans with which I am not yet credentialed?

Question: I'm planning on opening a new office. I have only been able to be credentialed by a few insurance companies. How do I go about charging patients on plans with which I am not yet credentialed?

Answer: There are no easy answers here. Some insurers will review partial contracts and - if you provide the missing pieces - will expedite your application.

Conversely, some practices hold the billing and wait for the credentialing to be complete (not recommended, as you may pass timely filing limits). Other practices bill the physician as a locum tenens. This is usually contract-dependent, and you may want to contact the health plans you expect to credential you to determine whether this is an option for you.

Still other practices submit claims knowing they will be denied, and then resubmit them once the credentialing is complete. Again, this may or may not work, depending upon your final contract language.

Some write off the work due to "non-covered provider;" however, you obviously shouldn't pursue this option unless you have to - it will cost you too much money.