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

[kpina613]

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 would like to do is be contracted with some insurance companies for the office visits but stay out of network for all pregnancy global services. Is this something that is possible, if so how would I go about credentialing it this way? Thank you!

 

[csperoni]

It MAY be possible, depending on the carrier and some additional logistics setup.
With the same TaxID, it is not possible to be participating for one office visit and be out of network for another office visit.
With DIFFERENT TaxIDs, SOME payors will allow a clinician to be participating with only one of them. You would have to contact each carrier to determine this.
Even for payors that DO allow it, you also run into the issue about seeing a patient first for a "covered" service, then patient gets pregnant and then those visits wouldn't be covered. Only the patients being seen out of network would need Good Faith Estimates under the No Surprises Act (which I assume you are doing now anyway).
Just curious if you do submit claims on the patient's behalf as a courtesy as out of network. Or you have the patient pay and simply hand them an itemized receipt? If so, expect to have some of your out of network claims processed incorrectly as in network.
Summary:
Is it possible? Yes, for some carriers.
Would I advise it? Absolutely not. There are so many things to go wrong.
If you did decide to try it, maybe try with just one or two carriers and see how that goes.