Unreported prodvider change- submitting corrected claims


St Petersburg
Best answers
Does anyone have any experience in how to best handle a situation in which a provider left a practice and another provider took over continued care but the practice did not notify the billing company that this change had occurred? I have a practice in which the credentialed OT left suddenly and the not yet credentialed OT that was just hired by the group took over the patients. The practice did not realize that they could not just continue to use the credentialed provider, and did not notify me of the change. How best to minimize damage and appeal/request retroactive authorization for an out of network provider in this extenuating circumstance. Also, does anyone know what the rules would be for submitting the corrected claims would be? Now that I know they are wrong I have them all corrected and on hold until I know what to do. If they are going to recoup all of the payments at once it will be too much for this small practice to handle. We would need to reimburse the money slowly if there is no way to appeal. The insurances affected by this are Amerigroup and BCBS of TN. As things stand right now, we have errors...I need to make sure that this is handled in a way that it does not become fraud! I have never imagined that a practice would not know that you can't use the NPI of a person who is no longer in the building...it boggles my mind. Apparently they thought that once they credentialed one OT they had created a situation that they were just good to go forever. Thank you for any shared experiences or advice