BCBS of Kansas has not historically required any provider be credentialed in order to be participating. When adding a new provider to a group, we simply had to fax them a request to add the provider, and they would send us an application to fill out. We would submit the application and BCBS would set the effective date we requested, including any back dating if necessary.
BCBS is now required to have their entire current provider network credentialed by August 1, 2013 (to include the following provider types: MD, DO, DPM, PA, APRN, PhD, LSCSW, LCMFT, LCPC, LCP, LPT, DDS, OD, and DC – CRNAs are not currently required to be credentialed). For any of the listed provider types requiring credentialing, it will be very important you notify ABI of new providers being added to your practice as soon as you become aware of the addition. The credentialing process can take 90-120 days and BCBS will not back date any effective dates. The effective date will be the date the credentialing process is complete. If a provider is seeing BCBS patients and has not completed credentialing, those claims will be processed as out-of-network, creating a higher patient responsibility/out of pocket. Please be advised, you will need to notify ABI as soon as you realize you will be adding new providers.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
No Comments