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Thread: Out of state provider

  1. #1

    Question Out of state provider

    AAPC: Back to School
    An out of state provider has come to assist my provider in surgery. Should the out of state provider charges be entered into my system (credentialing has not been done), or should the out of state provider have his practice enter the charges in to his system?
    Where would I look for these regulations?

  2. #2
    Join Date
    Apr 2007
    Lubbock, TX


    Check with the payer for individual policies - it seems like it's variant; here's an example policy from Medi-Cal:

    18. What is a temporary out-of-state provider?
    The Out-of-State Provider Unit may enroll certain out-of-state providers and allow payment for up to $599.99, or 10 paid claim lines per calendar year, before they are required to complete the standard enrollment forms. Once this billing limit is reached, the provider is informed through a system-generated letter that enrollment as a permanent provider in the Medi-Cal program is necessary prior to receiving further payment. The letter instructs the provider to bill Medi-Cal again for non-paid claims after the Department of Health Care Services (DHCS) has received and approved a provider's enrollment. Providers unable to use the temporary enrollment format should complete the permanent provider enrollment forms available on the Medi-Cal Web site's Provider Enrollment Division (PED) Web page. For questions about which forms to use, contact the Out-of-State Provider Unit at (916) 636-1960.

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