Provider moving practice location

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1
Location
Clinton Township, Michigan
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0
Hello everyone!

We have a provider who left her previous practice, and is joining ours. We bill everything with our group NPI and tax ID, but individual NPI as rendering. We are in mental health, and she is our first prescriber (DNP). Everyone else at the practice is LPC, MSW, or LP.

She is only accepting two insurances at this time: BCBS and Aetna. I thought it was good news that she was already previously credentialed, but its turning to be more of a headache. With BCBS, it was no issue to change her practice location and group affiliation. Aetna is turning to be another story. Every time a call, I get a different answer. "She just needs to change location, submit letter of intent", "Submit an application", "It will take 6 months for her location/ new group to appear", "She can see patients immediately".

I'm torn on what to do, because she has multiple patients who have followed her from her old practice and would like to see her as soon as possible. She has the availability, but I keep pushing the appointments back, because I don't know if their insurance will cover their visit. I don't want them to be responsible for any additional out of pocket cost, or cost the practice any money!
Any feedback or experience with similar situations is appreciated!

Basically end question is: Does provider's location and group affiliation need to be in effect to start seeing patients? (Request already submitted to insurance.)

For now, I have spoke to provider and director, we are going to have her start with one Aetna patient, and see how the claim comes back before she sees anymore.
 
Messages
1
Location
South Hadley, MA
Best answers
0
Hello everyone!

We have a provider who left her previous practice, and is joining ours. We bill everything with our group NPI and tax ID, but individual NPI as rendering. We are in mental health, and she is our first prescriber (DNP). Everyone else at the practice is LPC, MSW, or LP.

She is only accepting two insurances at this time: BCBS and Aetna. I thought it was good news that she was already previously credentialed, but its turning to be more of a headache. With BCBS, it was no issue to change her practice location and group affiliation. Aetna is turning to be another story. Every time a call, I get a different answer. "She just needs to change location, submit letter of intent", "Submit an application", "It will take 6 months for her location/ new group to appear", "She can see patients immediately".

I'm torn on what to do, because she has multiple patients who have followed her from her old practice and would like to see her as soon as possible. She has the availability, but I keep pushing the appointments back, because I don't know if their insurance will cover their visit. I don't want them to be responsible for any additional out of pocket cost, or cost the practice any money!
Any feedback or experience with similar situations is appreciated!

Basically end question is: Does provider's location and group affiliation need to be in effect to start seeing patients? (Request already submitted to insurance.)

For now, I have spoke to provider and director, we are going to have her start with one Aetna patient, and see how the claim comes back before she sees anymore.


Along as you have register the provider with the Ins co. and have a effective date you should not have a problem. In the practice I worked for the doctor hired a PA. we billed he service under the groups billing provider number. Then on the rendering provider line is were the PA'S NPI number goes. The practice never had an issue of none payment. hope this helps
 

SharonCollachi

True Blue
Messages
1,358
Location
Clovis, CA
Best answers
3
Have her patient call their insurance company, write down the date, time, phone number, and name of person they spoke to, and a reference number for the call. Have them tell the insurance company that their provider joined a group (give the patient the Tax ID numbers and NPI numbers), and they can be told directly if it is covered or not. That way, if it denies, they have all of the information necessary to appeal, even if you do the appeal for them. You might want to do a form letter with all of the applicable information to give to patients so they can call, with blank spaces to write down the information quoted to them.
 
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