Wiki How to send claims on new doctor not attached to established group tax id TEXAS

[gr8gal61]

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!!!!!!!!!!!!

 

[mcewenass]

If I understand correctly the new physician that is joining your group is in the credentialing process correct? This process can be frustrating but it is extremely important that you do not bill under any other provider in order to get the claim paid. You may want to review the OIG Compliance for Small Group Practices and provide this to your physicians and or office manager. Here is a helpful link:
http://www.texmed.org/Template.aspx?id=6263

 

[RebeccaWoodward*]

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!!!!!!!!!!!!

As the previous poster stated, this should start the wheels turning. Below is the link~


Knowing misuse of provider identification numbers, which results in improper billing; 16

16 An example of this is when the practice bills for a service performed by Dr. B, who has not yet been issued a Medicare provider number, using Dr. A’s Medicare provider number. Physician practices need to bill using the correct Medicare provider number, even if that means delaying billing until the physician receives his/her provider number.

http://oig.hhs.gov/authorities/docs/physician.pdf