BCBS of Kansas is now requiring all healthcare professionals (including CRNAs) to be credentialed prior to being approved as a new participating provider. Previously they only required physicians to complete this process. With the addition of CRNAs, and other mid-level providers, now everyone must trudge through this task. This credentialing process requires each professional to be set up on CAQH (the Council for Affordable Quality Healthcare). BCBS of KS is currently working on all currently enrolled providers who have not already been through the CAQH credentialing process. As your name comes up for credentialing and you are not already set up with CAQH, you will be notified. You may receive a letter from BCBS stating it is time for re-credentialing. If you receive a letter, please forward to our office; so we can ensure you get credentialed with BCBS correctly.
BCBS of KS has also historically back dated effective dates for new providers. With the migration to CAQH, this will no longer be the case. Before a new provider begins seeing patients, that provider will have to go through the credentialing process and be approved PRIOR to seeing any BCBS patients, otherwise these cases will not be processed under the participation agreement. This becomes especially important for groups adding employees, as this would be in violation to the group’s participation agreement. Please be aware of this very important change, as it will be critical you give plenty of notice of any new providers you will be utilizing. However, BCBS of KS does recognize CRNA locums (unlike Medicare). If a CRNA is truly temporarily filling in for one of the regular CRNAs, who is absent from work, the locums will not have to be enrolled. Those services can be billed under the full time CRNA with a Q6 modifier. ABI will need to be notified of these situations, so the claims can be billed appropriately.
In other news:
Payor/Insurance Company Acquisitions
You will be noticing some changes around the corner with some of the insurance companies. Aetna has agreed to acquire Humana (for more information on the pending acquisition go to: http://www.AetnaHumana.TransactionAnnouncement.com )
Also, we are monitoring Anthem’s pending acquisition of Cigna.
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Editor: Philip Blann (pblann@anesthesiabilling.com).
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