1. E

    Wiki Help with New PA-C

    My office hired in a new grad PA-C (eff. 9/2023). Her first day with us was October 30, 2023 and we've ran into a few bumps in the road. Our biggest concern is: She is not yet credentialed with Medicare. I am not quite sure if since she is not yet credentialed with Medicare, if she's able to...
  2. M

    Wiki Covering Physician

    How can we ensure that our practice bills appropriately for a new provider who is not yet fully credentialed? Can we still bill with Mod Q6 even though the provider is still in the credentialing process and is most likely joining the practice?
  3. K

    Question Contracting for office but not global for a nurse midwife, is this possible?

    I am looking for some guidance and have been unable to find any good info on this. I have a provider who is a nurse midwife and she is wanting to start seeing patients in her office for things like paps and well women checks. She is not contracted with any insurance company currently. What she...
  4. S

    Credentialing expert needed

    Hello, Our practice is looking to hire a credentialing consultant (or full time) with about 45 physicians. Any referrals? They should have experience with all parts of credentialing including CAQH attestations, revalidations, enrollments, maintaining provider rosters etc. Competitive pay...
  5. A

    Question Credentialing Company vs. In-House Credentialing Specialist

    We currently have an In-House Credentialing Specialist that will be leaving later this year and are considering outsourcing the credentialing. Can you tell me the pros and cons of your experience with using a Credentialing company. Thank you.
  6. K

    AAPC Certified Professional Coder 17+yrs Experience Seeking Position

    Seeking a position pertaining to any or all the following job duties; office or dept. management, physician credentialing, bookkeeping, accounting, and/or medical coding, within a well-established practice. Resume attached Note: Not exploring entry level positions.
  7. E

    Question Aetna Credentialing/Contracting

    I work as the credentialing specialist for an ABA therapy group and experience the worst time with Aetna and their processes. Does anyone happen to know of anything helpful in moving along their process of credentialing, on boarding and demographic loading? I submit applications to Aetna and...

    Question Who outsources their credentialing?

    I am the Billing Manager for a physician owned practice that currently has 1 location with 12 providers. In early 2023 we will be opening a second location and adding more providers. Currently I handle all of the credentialing and it is starting to become more difficult to keep up with. Not only...
  9. B

    Wiki Credentialing Software

    We are looking for a credentialing software to utilize. What software have you used and what did you like or dislike? I appreciate your recommendations. Thank you
  10. 5

    Credentialing help

    Hi, Our prior employee that was our credentialing. department, has left. she spent time training the new person, but it was not enough time. Does anyone have any recommendations on what we can do to find out more information on credentialing or any workshops / webinars on credentialing? Thank...
  11. K

    Wiki New NP & POS

    I just started working for Primary care and I need some help with the Billing and POS for a New NP in a different location. In the process of hiring a New NP and she will be in a different location 1. New NP A she will use an OBGYN clinic on Wed and Thurs... The OB is closed on Wed...
  12. S

    Provider moving practice location

    Hello everyone! We have a provider who left her previous practice, and is joining ours. We bill everything with our group NPI and tax ID, but individual NPI as rendering. We are in mental health, and she is our first prescriber (DNP). Everyone else at the practice is LPC, MSW, or LP. She is...
  13. C

    Out of network billing!!

    Hello! Our practice just became in network with UHC as of June. Our effective date was 6/22/18, there was miscommunication with the rep from UHC and the person in our company who signed the contract. The person was under the impression that once the contract was signed and submitted back to the...
  14. E

    New provider credentialed but not associated with our practice yet

    We have a new provider that left a local practice to join ours. He is credentialed with the insurances but is in the process of being credentialed with our practice. No one told me his credentialing was incomplete so I've been billing under his NPI w/our tax id# since he started. We are...
  15. C

    Wiki New provider not credentialed with health plans

    Hi there, We have a new provider (an MD - not an NP) who is not quite credentialed with all the health plans our practice participates with. When she sees patients who have an insurance she is not credentialed with, I have been directed to bill those claims under another physician at the...
  16. S

    Credentialing question

    We have had some issues getting credentialed with Medicare. Our group effective date is 7/31/17, but our provider(we only have 1) is not assigned to the group effective until 10/1/17. Does anyone know of a way to get the claims from 7/31/17 to 9/30/17 processed without the providers name on the...
  17. C

    Contract Billing and Credentialing from Home

    Certified Coder and experienced billing and credentialing from home. Current knowledge of navigating current, complicated billing procedures and guidelines. Would love to talk to small, independent practice. If in the Dallas area, would be available to meet regularly in the office.
  18. D

    Taxonomy selection

    I am an office manager for small ENT/audiology practice in Texas. The doctor is listed with NPPES as group-single specialty. As I add the audiologists to her contracts, does that change her to group-multi specialty? If so, how do I go about changing her status with NPPES? Thanks!
  19. S

    Provides Under Same Tax ID/Different Location Not Credentialed

    All providers are under the same tax ID number. One doctor sees patients at another location, this doctor is the only provider credentialed at that location with BCBS. The example: Doctor #1 sees patients at location A and B. Doctor #2 only sees patients at location B. Doctor #1 was out...
  20. D

    Wiki Question regarding NP and covering a doctor while on leave

    Hello all, I have a doctor taking a medical leave and I am working with a locum tenens recruiter; they employ the NP. My question is, in order to direct bill does the NP have to be credentialed first or would we just bill under our doctors NPI? (The NP is paid by the recruiting company) I...
  21. K

    Credentialing and Proper Billing

    My practice is merging with a larger practice on 03/01/2016. we were told this last week...the incoming practice is saying that our Therapist who will remain for the next few months will still be seeing patients however we must bill under a therapist that is already credentialed to the new...
  22. T

    Independent Billing / Credentialing

    Hi All, I'm seeking tips on how to start up my independent billing and/or credentialing business. I've obtained my CPB from AAPC and want to work with new and/or private practice physicians. Any other info on software would be a plus as well. Your responses are welcomed and appreciated! Thanks!