Our contact at Value Options tells us all you must do in that instance is file a “change of address” with each insurer. If the group uses your tax ID (one that is solely yours), you are in good shape. We suggest you apply once to the Council for Affordable Quality Healthcare (see previous question) as a shortcut to the recredentialing process. According to an authority with the Value Options provider relations department, you have to recredential with those panels you want to be in again. The group probably bills under its tax ID, and you cannot use that number once you leave. Most will accept solo practitioners if there is a need in your geographic area or niche. Have you heard about this? Is there any way around this? Your thoughts would be appreciated.Ī: The reason you may be dropped from a managed care or insurance panel is not because they aren’t contracting with individual providers. Reportedly, the reasoning is that they are not contracting with individual providers at this time. I am planning on leaving the practice to start my own individual practice but have heard some concerning stories about people who have tried to leave group practices only to find out that some of the insurance companies were going to drop them. I am credentialed with most insurance companies, including most of the major managed care companies. Go to and apply online or request a paper application. At our last private practice seminar in Chicago in June, most participants were unaware of CAQH and its benefits. This is a free service where you apply once, and more than 100 managed care and insurance companies will be able to access your information, saving you the time of applying to each individual company. The word from Blue Cross Blue Shield is that it will notify counselors “when they can begin submitting their NPI on standard electronic transactions prior to the May 23, 2007, compliance date.”Īn additional note: We cannot emphasize enough the importance of credentialing through the Council for Affordable Quality Healthcare (see our June 2006 column in Counseling Today). Once you have obtained your NPI, don’t use it until May 23, 2007, or until you are notified by the various insurance and managed care companies. If interested, contact NetSource Billing at 866.441.1591. In addition, a service provided by a group called NetSource Billing will apply for an NPI number for you for a $25 fee. With your permission, your employer or professional association can apply for NPI on your behalf. Counselors may also call the enumerator and request a blank application form. A copy of the application form, which includes the enumerator’s mailing address, can be found at. You can obtain an NPI (if you haven’t already!) by doing one of the following: Most health plans, private health insurance issuers and all health care clearinghouses must accept and use NPIs in standard transactions by May 23, 2007. Therefore, each counselor will have just one ID number (the NPI) to use for every insurance and managed health care company. This NPI will replace the various provider identification numbers (ID numbers issued by insurance companies) that counselors use to bill insurance and managed care companies. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that all health care providers have a National Provider Identifier (NPI). Let’s back up a minute, however, and explain the NPI process. Q: Why would I need a National Provider Identifier number if I never plan to electronically bill insurance or managed health care companies?Ī: By May 23, 2007, counselors will need a National Provider Identifier number whether they bill an insurance company electronically, through a website or via paper HCFA.
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