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Billing Service From Out of State

telemind

New
Messages
7
Best answers
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If registered as a preferred provider with major commercial insurances (BCBS, CIGNA, Tricare ect.) aside from Medicaid and Medicare. Can we bill services being provided in a different state without having to individually go through the process of becoming contracted once again with the local insurance in that state?
  • If yes, why?
  • If no, why not?
  • How long would the process take for us to obtain registration with AZ local insurance? As we are already contracted in the state of NV.
 

mitchellde

True Blue
Messages
13,306
Location
Columbia, MO
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0
Is this a one time emergent encounter or does the provider regularly see patients in a different location. If the provider has a location in a different location then yes you must credential the provider for that location and the claim must reflect the services have been provided at that physical address. You cannot use the address of where you are presently for services rendered in a different location. The reason is rates can be and are different between zip codes and Fiscal intermediaries can be different for the same payer once you cross state lines.
no idea how long it will take to get this , but in the meantime you will need to submit the claims with the address of where the service is performed and maybe accept that it may not be paid.
 

thomas7331

True Blue
Messages
2,042
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0
I agree with the above, and would add that your providers must also be separately licensed to practice that state and carry malpractice coverage in the state where they are practicing. Each state regulates medical practices differently - it's not simply a matter of crossing the state line and offering services. Setting up a practice in a different state really requires going through the entire process. Some insurance plans may contract across a state line to allow their covered patients living in areas near a border to have access to providers in a different state, but that is a different thing from a provider going into a different state to practice.
 

telemind

New
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7
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0
Thank guys for the answers!! Although Im still a bit confused.
We are currently in Las Vegas, NV. Our doctor would be expanding to Phoenix and is also already licensed there. We are also contracted with BCBS, Tricare, Cigna and so on in the state of Nevada with his national provider number would he still need to register with the local insurances in Phoenix? Also, we see the majority of our patient's via telemedicine
 

thomas7331

True Blue
Messages
2,042
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0
My recommendation would be to get on the phone with your provider reps and talk to them about this. Different payers will have different policies for telemedicine and different requirements for what is needed to bill the services your are planning for patients located in a different state. You are better off working with them directly to make sure you have everything set up correctly. If possible, get them to send you instructions in writing, and work with them to get it all set up. That way, you will have some accountability from them if there's a problem with the billing down the road. You may get some answers here on the internet, but if you get incorrect information, you'll have nothing to fall back on if you end up with a bunch of denials on your hands later on. It would not be a bad idea to speak to your practice attorney as well just to ensure you have all the necessary regulatory paperwork in place for offering services across state lines.
 
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