Results 1 to 2 of 2

Out of state provider

  1. Question Out of state provider
    Medical Coding Books
    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
    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.

Similar Threads

  1. can the rendering provider and referring provider be same
    By arunp_001 in forum Medicare Regulations
    Replies: 2
    Last Post: 03-02-2013, 01:15 PM
  2. Actual Provider Vs Billing Provider
    By YesicaRuedas in forum Billing/Reimbursement
    Replies: 1
    Last Post: 02-27-2013, 04:02 PM
  3. Billing for out of state provider
    By SCCL5558 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-30-2012, 09:52 AM
  4. Billing for a provider out of state
    By SCCL5558 in forum Employment General Discussion
    Replies: 0
    Last Post: 07-30-2012, 09:46 AM
  5. Out of State Provider - Assistant Surgeon
    By elisahunt in forum Billing/Reimbursement
    Replies: 0
    Last Post: 12-23-2010, 09:52 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.