gr8gal61
Guru
Does anyone know the correct way to show the new physician to our already credentialed practice that has not been either credentialed with some of the bigger payers or his NPI attached to our tax id?
I have been putting the GROUP NPI in box 33 and him as the rendering provider along with his NPI in box 24J however several bigger payors are denying claims stating "the entity not eligible for benefits submitted dates of service".
The normal credenitaling process for a new physician at this office is get the doctor credentialed in Medicare with an 855R to attach the tax ID to the new doctors' NPI. Then the hospital privileges credentialing begins. I use SPA (southwest physician administrators) which is an IP that gets the doctor credentialed in numerous large insurance companies for a yearly fee HOWEVER he must have hospital privileges in order to file the application with SPA...therefore majority of the claims are being denied.
There is a new office manager that has just relocated to Texas and is NOT certified as a coder and is telling the other biller & I that we need to put the doctor that IS credentialed on the claim and the NEW doctor as the "referring doctor" in box 17 however this is not right and I know better but i need some direction as to where I can find the answers to this question!!!!!!!!!!!!
I have been putting the GROUP NPI in box 33 and him as the rendering provider along with his NPI in box 24J however several bigger payors are denying claims stating "the entity not eligible for benefits submitted dates of service".
The normal credenitaling process for a new physician at this office is get the doctor credentialed in Medicare with an 855R to attach the tax ID to the new doctors' NPI. Then the hospital privileges credentialing begins. I use SPA (southwest physician administrators) which is an IP that gets the doctor credentialed in numerous large insurance companies for a yearly fee HOWEVER he must have hospital privileges in order to file the application with SPA...therefore majority of the claims are being denied.
There is a new office manager that has just relocated to Texas and is NOT certified as a coder and is telling the other biller & I that we need to put the doctor that IS credentialed on the claim and the NEW doctor as the "referring doctor" in box 17 however this is not right and I know better but i need some direction as to where I can find the answers to this question!!!!!!!!!!!!