Pediatric Coding Alert

Question: We have a new doctor in our practice and she has not been added to our Medicaid plan. We are in the process of adding her, but until she has been added, can we bill the claims under the doctor who owns the practice?

Answer: You should not use another credentialed doctor’s unique physician identification number on the new doctor’s Medicaid claims. Some practices hold all the new doctor’s claims until credentialing is complete, and then submit them. Before doing that, you should ask your state Medicaid carrier whether that is permissible.

A carrier may sometimes permit a special surrogate number for the identifying number, as with residents or interns. Ask your carrier if any surrogate numbers apply to your situation.

Another option is to have the doctor only see non-Medicaid patients until the Medicaid credentialing process is complete. Medicaid carriers can take several months to complete credentialing, so if your practice is expecting a new physician, start the process well before the arrival date so claims can be submitted promptly.