fhalamuda
New
I appreciate anyone who will attempt to comment on my question. It is a difficult question to word but maybe not a difficult one to answer. So, thank you in advance for trying to make sense of my question.
Though I am not a credentialing expert, I do understand the general purpose, basic concepts, and basic steps in credentialing with individual payers.
To minimize the complexity of scenarios, it might help to assume that all established individual radiologists in my practice are contracted with, and in network with, both payers in my example. A new radiologist come aboard and their credentialing is quickly completed with Aetna but their credentialing with UHC is started but not yet completed. Final point in my example is a patient needs imaging and the patient has Aetna primary and UHC secondary.
I know that it is probably best to have a radiologist who is already credentialed with both payers complete the diagnostic interpretation for this patient's imaging.
And now my two-part question:
1. What are likely billing risks if the new radiologist - instead of a fully credentialed radiologist - interprets the study?
2. Do the risks change with the same radiologist if the patient's primary and secondary coverage are the reverse - UHC (not credentialed) primary and Aetna (credentialed) secondary?
Thank you much.
Though I am not a credentialing expert, I do understand the general purpose, basic concepts, and basic steps in credentialing with individual payers.
To minimize the complexity of scenarios, it might help to assume that all established individual radiologists in my practice are contracted with, and in network with, both payers in my example. A new radiologist come aboard and their credentialing is quickly completed with Aetna but their credentialing with UHC is started but not yet completed. Final point in my example is a patient needs imaging and the patient has Aetna primary and UHC secondary.
I know that it is probably best to have a radiologist who is already credentialed with both payers complete the diagnostic interpretation for this patient's imaging.
And now my two-part question:
1. What are likely billing risks if the new radiologist - instead of a fully credentialed radiologist - interprets the study?
2. Do the risks change with the same radiologist if the patient's primary and secondary coverage are the reverse - UHC (not credentialed) primary and Aetna (credentialed) secondary?
Thank you much.