Wiki New provider not credentialed with health plans

[caitlingconnors]

Hi there,

We have a new provider (an MD - not an NP) who is not quite credentialed with all the health plans our practice participates with. When she sees patients who have an insurance she is not credentialed with, I have been directed to bill those claims under another physician at the practice. Is this acceptable? If anyone can provide me with some guidance on this I would appreciate it greatly!!

-Caitlin

 

[mitchellde]

you cannot bill the services provided by one MD under the NPI of a different MD, that would constitute a false claim. An MD cannot provide services incident to another MD. Only Mid-level providers may be billed incident to once the rules are met. You should search under false claim and incident to rules.