Hi there. Thank you for your inquiry but I do not offer Credentialing services. I do, however, offer a credentialing course to teach people. The link is in the video description. You can also watch a recently released video to scan the QR code at the beginning and it will take you to the website directly.
Thank you for watching! Box 32 will have the servicing facility, so the address where the services were rendered. Box 33 has the Billing Facility- the company NPI that is on the contracts with insurances. You might have multiple different servicing facilities if you have multiple locations for your company, but most of them are all going to have the same billing facility, which is what goes in box 33. Sometimes it will be the same in both places. I hope this helps!
Quick question-- I am credentialed and contracted with Medicaid through my NPI 1 as a PRN employee from a clinic. I started my own practice and have NPI type 2 now as well, but my NPI 2 is not credentialed or contracted with anyone. I have a potential client looking for my services through my private practice and they are Medicaid. I provide a specialization that they are unable to find in another provider. Am I able to 1- bill under NPI 1? 2- do a special contract for this specific family and remain private pay for my NPI 2 business? Or am I required to go through the process for my NPI 2? Hope that makes sense.
Thank you for your question. You cannot bill until you have an individual contract whether that is under your sole proprietorship using TIN and NPI 1 or your group using TIN and NPI 2. My guess is the clinic you work PRN has you affiliated under their group contract unless you’re a 1099 employee and they bill you as an individual and not under their group. You will not get paid unless your TIN (if you don’t have one for your business then you need to get one) and NPI has a contract specifically written and approved for you separately. I hope this makes sense. You can charge everyone as self pay under your business until you get contracts. Once you obtain contracts, then charging self pay can get a little more restrictive as you will not be able to collect any money from Medicaid patients once you are contracted, and will have to except payment in full from Medicaid reimbursement for the services unless a patient has a small cost share based on their MCO plan
I have a question. If I am in network under an individual contract through one tax ID/NPI2, will I be treated as in network or out of network under a different tax id/NPI2? Thanks for the helpful video!
Thank you for watching and the question. Any new TINs and NPIs needs to be associated to a contract, either existing or a new one. You would need to contact the insurance to get them added or changed (depending on your needs) and find out what they require. If keeping existing and adding new ones, they may require a separate contract or you may want one depending on specialty and accounting/business structure reasons.
Thanks so much for your quick reply Jennifer! I'm actually trying to make my new practice OON while maintainig my old INN practice. I'm worried that the insurance companies might say that I'm violating my contact by doing so, or try to claw back OON reimbursements years later by saying I should have submitted the claims INN despite providing the services under the new tax ID/NPI 2. For example, one individual contact said to notify the insurance carrier if I changed tax IDs. So, could this be an issue for my individually contacted insurances from the original tax id? Would it be an issue for my group contacts? Thanks!
Sure, thank you for asking and watching. An EIN is an employer identification number, and it is issued by the United States Internal Revenue Service when a business applies for one. A Social Security number is an individual persons identification number issued by the US Government. It is strongly discouraged to use this in place of an EIN. An EIN is also called a TIN or Tax Identification Number. Usually a sole proprietor, that bills only for themselves could use their Social Security number, or they can apply for an EIN to use in place of that. All groups have an EIN.
Will Medicaid (Texas) retro bill while a provider is waiting for credentialing? I am just starting the application under my NPI 2 because I was told you had to do the NPI 1 first. But now I need to hire help. I’m a SLP.
This is a little bit of a complex answer, so please bear with me. TX Medicaid will often times retro-cover claims to the effective date, if they provide you with an effective date in the past. Sometimes insurances will only provide an effective date in the future and then you cannot retro bill any dates of service for coverage/payment prior to that date unless the patient has out-of-network benefits. You would need to call the payer to find out if they will and how far back they will go to cover. In Oregon, Medicaid uses the date on the application submitted to them as the "effective date" (ex: so if the application is signed and dated for 3/1/23, but they do not receive until 3/2/23 or after, they use the date of the signature on the application. All patients seen from 3/1/23 will be covered, assuming they approve the application and the claims can be held and submitted once the final approval comes from the insurance. The insurance would not process the claims as "in-network" until the approval is final, thus why you would hold claims until then assuming you choose to see patients with that insurance in the interim). All plans are different. The MCO plans (Superior Health, First Care, etc.), however, will not normally retro-cover. You can always ask. The worse they can say is no. You can bill under your NPI 1 (individual NPI) depending on how you are set-up as a business. If you are a sole-proprietor then it should not be an issue billing with your NPI 1 and SSN. If you are set up for anything other than that, it is often better to bill under your NPI 2 (group NPI) and business EIN/TIN. It is correct, you have to be credentialed with your NPI 1 at every payer as an individual before you can move onto being added to a group, assuming the group is already contracted with the payer. I hope this helps. Thanks for watching!
@@navigatingthebusinessofmed8251 Thank you so much for responding. I am working on applying as a group to everyone now so that I can add other clinicians to my practice.
Hello Jennifer, if we got a contract with insurance payers as primary care and along the way we start to provide mental health and we need to add another provider LP or LPC, do we need to change or add mental health to our contract or adding the LP itself is going to change the contract
That is a good question. I would contact your provider relations person at the payers and ask what they feel would be easiest. I would also look at the qualifications for billing the mental health codes. You may just need to add an additional taxonomy to your contract to recognize mental health, or you may be okay. Only certain mental health professionals are able to contract with Medicare and other payers, so definitely investigate that further too in regards to who can bill what services.
Can the provider that owns the clinic just bill everything under their NPI 2 and their own NPI 1 number instead of adding all providers that work at the clinic?
Per billing guidelines, all providers rendering services have to be billed out on claims under the "Rendering Provider," other than a few instances where locum tenens is being billed, or "Incident To" is being billed. These two exceptions have very strict requirements and limitations in doing so as well. It is best to consult with insurances about these specific situations prior to billing with these to avoid any compliance or regulatory infractions. Also keep in-mind professional liability coverage and limitations as well when it comes to billing practices. Many people forget to consider that. Thanks for the question and thank you for watching!
I would love to hear more from you about Credentialing Services
Hi there. Thank you for your inquiry but I do not offer Credentialing services. I do, however, offer a credentialing course to teach people. The link is in the video description. You can also watch a recently released video to scan the QR code at the beginning and it will take you to the website directly.
Good information. Could you please redo this with more details on how will this individual vs group billing affect hcfa specially box 32 and 33
Thank you for watching! Box 32 will have the servicing facility, so the address where the services were rendered. Box 33 has the Billing Facility- the company NPI that is on the contracts with insurances. You might have multiple different servicing facilities if you have multiple locations for your company, but most of them are all going to have the same billing facility, which is what goes in box 33. Sometimes it will be the same in both places. I hope this helps!
Quick question-- I am credentialed and contracted with Medicaid through my NPI 1 as a PRN employee from a clinic. I started my own practice and have NPI type 2 now as well, but my NPI 2 is not credentialed or contracted with anyone. I have a potential client looking for my services through my private practice and they are Medicaid. I provide a specialization that they are unable to find in another provider.
Am I able to
1- bill under NPI 1?
2- do a special contract for this specific family and remain private pay for my NPI 2 business?
Or am I required to go through the process for my NPI 2?
Hope that makes sense.
Thank you for your question. You cannot bill until you have an individual contract whether that is under your sole proprietorship using TIN and NPI 1 or your group using TIN and NPI 2. My guess is the clinic you work PRN has you affiliated under their group contract unless you’re a 1099 employee and they bill you as an individual and not under their group. You will not get paid unless your TIN (if you don’t have one for your business then you need to get one) and NPI has a contract specifically written and approved for you separately. I hope this makes sense. You can charge everyone as self pay under your business until you get contracts. Once you obtain contracts, then charging self pay can get a little more restrictive as you will not be able to collect any money from Medicaid patients once you are contracted, and will have to except payment in full from Medicaid reimbursement for the services unless a patient has a small cost share based on their MCO plan
I have a question. If I am in network under an individual contract through one tax ID/NPI2, will I be treated as in network or out of network under a different tax id/NPI2? Thanks for the helpful video!
Thank you for watching and the question. Any new TINs and NPIs needs to be associated to a contract, either existing or a new one. You would need to contact the insurance to get them added or changed (depending on your needs) and find out what they require. If keeping existing and adding new ones, they may require a separate contract or you may want one depending on specialty and accounting/business structure reasons.
Thanks so much for your quick reply Jennifer! I'm actually trying to make my new practice OON while maintainig my old INN practice. I'm worried that the insurance companies might say that I'm violating my contact by doing so, or try to claw back OON reimbursements years later by saying I should have submitted the claims INN despite providing the services under the new tax ID/NPI 2. For example, one individual contact said to notify the insurance carrier if I changed tax IDs.
So, could this be an issue for my individually contacted insurances from the original tax id? Would it be an issue for my group contacts?
Thanks!
This comment was still from me. it just came out from another account of mine by accident.
Will you please define the difference between EIN and SSN ?
Sure, thank you for asking and watching. An EIN is an employer identification number, and it is issued by the United States Internal Revenue Service when a business applies for one. A Social Security number is an individual persons identification number issued by the US Government. It is strongly discouraged to use this in place of an EIN. An EIN is also called a TIN or Tax Identification Number. Usually a sole proprietor, that bills only for themselves could use their Social Security number, or they can apply for an EIN to use in place of that. All groups have an EIN.
Will Medicaid (Texas) retro bill while a provider is waiting for credentialing? I am just starting the application under my NPI 2 because I was told you had to do the NPI 1 first. But now I need to hire help. I’m a SLP.
This is a little bit of a complex answer, so please bear with me.
TX Medicaid will often times retro-cover claims to the effective date, if they provide you with an effective date in the past. Sometimes insurances will only provide an effective date in the future and then you cannot retro bill any dates of service for coverage/payment prior to that date unless the patient has out-of-network benefits. You would need to call the payer to find out if they will and how far back they will go to cover. In Oregon, Medicaid uses the date on the application submitted to them as the "effective date" (ex: so if the application is signed and dated for 3/1/23, but they do not receive until 3/2/23 or after, they use the date of the signature on the application. All patients seen from 3/1/23 will be covered, assuming they approve the application and the claims can be held and submitted once the final approval comes from the insurance. The insurance would not process the claims as "in-network" until the approval is final, thus why you would hold claims until then assuming you choose to see patients with that insurance in the interim). All plans are different. The MCO plans (Superior Health, First Care, etc.), however, will not normally retro-cover. You can always ask. The worse they can say is no.
You can bill under your NPI 1 (individual NPI) depending on how you are set-up as a business. If you are a sole-proprietor then it should not be an issue billing with your NPI 1 and SSN. If you are set up for anything other than that, it is often better to bill under your NPI 2 (group NPI) and business EIN/TIN. It is correct, you have to be credentialed with your NPI 1 at every payer as an individual before you can move onto being added to a group, assuming the group is already contracted with the payer.
I hope this helps. Thanks for watching!
@@navigatingthebusinessofmed8251 Thank you so much for responding. I am working on applying as a group to everyone now so that I can add other clinicians to my practice.
Hello Jennifer, if we got a contract with insurance payers as primary care and along the way we start to provide mental health and we need to add another provider LP or LPC, do we need to change or add mental health to our contract or adding the LP itself is going to change the contract
That is a good question. I would contact your provider relations person at the payers and ask what they feel would be easiest. I would also look at the qualifications for billing the mental health codes. You may just need to add an additional taxonomy to your contract to recognize mental health, or you may be okay. Only certain mental health professionals are able to contract with Medicare and other payers, so definitely investigate that further too in regards to who can bill what services.
Can the provider that owns the clinic just bill everything under their NPI 2 and their own NPI 1 number instead of adding all providers that work at the clinic?
Per billing guidelines, all providers rendering services have to be billed out on claims under the "Rendering Provider," other than a few instances where locum tenens is being billed, or "Incident To" is being billed. These two exceptions have very strict requirements and limitations in doing so as well. It is best to consult with insurances about these specific situations prior to billing with these to avoid any compliance or regulatory infractions. Also keep in-mind professional liability coverage and limitations as well when it comes to billing practices. Many people forget to consider that. Thanks for the question and thank you for watching!