Q: I would like to ask you a question about how insurance credentialing has been provided on behalf of Therapists of XYZ.
I heard something that there is likelihood that the company doing insurance credentialing has been providing insurance credentialing for Joseph and Mary as for practitioners which are individual and not as a first insurance credentialing XYZ which has been credentialing them as a group with the carrier and consequently credentialing Mary and Joseph under the group paneling as clinicians.
Please are you able to confirm that Thriveworks has been looking for acquiring XYZ group insurance credentialing for the carriers which are not paneled with the agency yet? On the target list there are some carriers which are already paneled with XYZ, however there still are carriers which we have to approach. Due to this I need you to provide some clarification for me to know how to handle this matter.
A: Hello George, you asked me a really good question and I am able to give you an answer. Mary and Joseph were insurance credentialed both under your practice group and also independently.
The outcome of this is that Mary and Joseph are insurance credentialed to practice at practice of your group and also to charge under the tax- id number which is assigned for your practice. Right now, they are not authorized for practicing anywhere else, however if they want to change or add the tax- id number to their billing practice, they may have a foot in the door with other companies.
A group practice insurance credentialing issue is handled differently, according to various insurance companies. Some of them have completed the application for the group which they sent as a first, and it is before we are able to add providers to the practice group. (There are also the cases when at the same time they sent three applications where one is for Mary, second for Joseph and the third is for the group.)
Other insurance companies add to their system the group after we insurance credential first provider of practice. For instance: company send in Joseph´s application with tax ID number together with the information about group and then both the group and the Joseph are put into the insurance system of the company.
I am really glad you are concerned about Joseph and Mary´s “wrong” insurance credentialing. It is due to the fact that they are insurance credentialed independently in lieu of the company where getting credentialed and after that also being under them (what protects the company).
Five years ago, I also faced similar concernment when for my own practice I first began insurance credentialing providers. I can assure you that their insurance credentialing is the only right way of insurance credentialing which works for practices of groups.
I hope this was helpful for you!