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Thread: Provider/Billing question

  1. #1

    Red face Provider/Billing question

    AAPC: Back to School
    Hello all, I was wondering if anyone may be abel to help with my billing question. We have a provider that assised a c-section but is not set up with the insurances. So i was wondering if i could bill under one of our other providers that we have in the office like our MD or our midwife. Preferabley our midwife? We have a locum here and i know that you can do that with a locum but she is not a locum. Thank you

  2. #2
    Join Date
    Apr 2007


    I would not bill under another provider-- that is considered to be fraud. If this particular provider is not 'set up' with the insurance companies then she would be considered out of network until she is contracted with the insurance companies.

  3. #3


    You can not bill under another provider's name. I would check with that specific carrier, if you have submitted the credentialing information, they may backdate his effective date so you can hold the billing until they are actually showing as effective.

  4. #4
    Join Date
    Apr 2007
    San Antonio, Tx


    Wow! Can you say "FRAUD" any louder??!! What or who has given you the idea that this is acceptable? It is NEVER acceptable to bill under a provider who was not at the procedure or, if billing incident to, the "Supervising" provider is NOT in the same suite as the procedure that is being performed. The only time that this maybe be different would be in a "teaching" facility. I have never worked in that type of setting, so I can not say for sure. Good luck and remeber that if it "seems" wrong, it probably is.
    Ray Galvez CPC

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