New Physician-Awaiting on Insurance Credentialing - Billing under Another Physician

[bbernal]

I have told my practice owner that billing insurance for a non-credentialed physician under a credentialed physician is not permitted, but would like to provider other supporting evidence from other professionals in this forum.

If you have in-depth knowledge regarding this I would appreciate your input.

 

[CBLENNIE]

I work for an insurance carrier, and we would not accept claims billed under a credentialed provider when the services were performed by another provider, credentialed or not. The name of the rendering provider in box 31 of the HCFA 1500 needs to be the provider who performed the services, unless it were a shared/split visit.

However, not all insurance carriers are the same so you need to check with the ones that you contract with to find out what their processes & procedures are for credentialing new providers and what you can and cannot bill for a non-credentialed provider who is in the process of becoming credentialed.

If you search the forums for the termed "credentialed" you will find that this is a fairly common question and there is some good advice and recommendations on how to utilize the services of the new non-credentialed practitioner while you are waiting for their credentialing is complete and they are considered in-network with each insurance company.

 

[amyjph]

There have been a lot of discussions about this. As suggested above: try searching in the forums here using words like, billing under another provider, non-credentialed, credentialing, etc.

 

[trarut]

That is effectively an incident-to billing relationship, which is not permitted between physicians. I recommend that you limit scheduling for that provider for the time being to the payers that they are credentialed for.