Brand New Office Non par & provider non par- Getting started


Asbury Park, NJ
Best answers
Hey! I have worked in an out of network office setting, but I am now assisting in the start up with a new office. He is non participating and is a brand new office. He wants to remain out of network, but how do I let insurance companies know who he is, Tax ID, NPI, etc so that we are able to bill, verify benefits, etc? It has been difficult to get a rep on the phone or a rep in the correct departments. Any information would be great, thanks.


True Blue
Clovis, CA
Best answers
You will be sending your first claims on paper with a W9 attached. After that, some insurances will allow you to bill electronically and some will only allow that for participating providers.

If you are out of network, you won't be able to verify benefits, and frankly, you don't need to, as you will be charging your patients full fee on every visit. The insurances may pay you or they may pay the patient; only time will tell. So at first, you will have the patient pay the full amount up front. Over time, you will learn, for example, that Blue Shield will send you a check for 50% of what you bill and call it "usual and customary." From there forward (once their credit has been used up), you will have the patient pay 50% up front because you know Blue Shield will pay you the rest. And perhaps you will learn that Aetna will send a check to the patient, so those patients will always pay full fee up front. These are ONLY examples and are not real-world situations... I don't want someone reading this coming back and being upset because Blue Shield paid the patient instead of the doctor!