July 7, 2020
By New England Accounts Receivable Management
ALTHOUGH COVID 19 HAS DIMINISHED MUCH OF THE ORDINARY HOOP-LAH SURROUNDING THESE HAPPY AND MONUMENTAL OCCASIONS, MEDICAL SCHOOLS AND PROGRAMS ARE PRESENTING GRADUATES WORTHY OF MUCH APPLAUSE. CONGRATULATIONS TO ALL WHO HAVE EARNED THEIR DEGREES.
As Fellows and Residents move on to join practices, or start their own, it is crucial to investigate their “carrier credentials”. If you are an existing practice, adding the new Clinician as an employee, they must first be individually credentialed and then added to your group in order for their services to be billed to carriers and the practice to be properly reimbursed.
Easier said than done as most carriers now quote a 60-90-day turn-around of applications after submission date. This presents the problem of how to be reimbursed for services rendered during that time period.
Unfortunately, there is no way but to get applications in asap with a start date at least 30 days prior on the application and hope the carrier uses that date as the enrollment date. In any case, you will have to hold claims until the Welcome Letter arrives from the carrier, confirming the start date for eligible submissions. Any billing prior to that date will not be considered.
Any Clinician who has “moon-lighted” during training will have PTAN (Provider Transaction Number) numbers and in this case, they only need to be added to your group number with the carrier. A much easier process but watch the start date on these apps.
If applying to Medicare for an individual PTAN number, complete form 855I and submit online through PECOS or mail application to carrier handling your jurisdiction.
If tying PTAN to an existing group number, complete form 855R through Pecos or mail.
Blue Shield has all applications online (if MA practice) under Provider Central, Office Resources, Credentialing and Enrollment. Choose by Specialty.
Optum uses an online application under: Professionals.optumcare.com/credentialing
Harvard Pilgrim uses online application under: HarvardPilgram.org/Physician Credentialing
MassHealth is under: Mass.gov/Masshealth- Provider-Enrollment-and-Credentialing-pec
Call, email or text for any help needed and I will do my best to get you answers. Diane.firstname.lastname@example.org, 781-449-3400