Q: I would like to ask you a question about how insurance credentialing has been provided on behalf of the Therapists at XYZ Medical Center (my company).
I heard that there is a likelihood that your company has been credentialing my therapists, Joseph and Mary, as independent practitioners and not exclusively as a group under XYZ Medical Center. Consequently, with the credentialing services provided, I understand, that Mary and Joseph can now practice as independent clinicians, outside of XYZ Medical Center. Is this correct?
A: Hello George, you asked me a really good question. Here’s the answer: Mary and Joseph were credentialed both under your practice (XYZ Medical Center) and also independently.
The outcome of this is that Mary and Joseph are credentialed to practice in your group and under your practice’s tax- id number. Right now, they are not authorized to practice anywhere else, or independently. However, if either of them ever wanted to change or add the tax-id number to their credentialing contracts, they may be able to do this (and maybe not, depending on the company).
A group practice insurance credentialing contract is handled in various ways, depending on the insurance company. Some companies issue group contracts only if your practice has a certain number of clinicians (10-20 often), and some just don’t issue group contracts at all (they credential everyone independently and add your tax-id number as the billable entity).
Five years ago, I also faced similar concern when credentialing providers at my own practice. I wondered, “Shouldn’t they all be credentialed under a group contact?”
I can assure you that Mary and Joseph’s insurance credentialing is accurate, and they are credentialed the best way to work at XYZ Medical Center. Call us if you have any more questions, or require any more specific details!