Linking an in-state provider to your group

You hired a new physician. The practice he’s transferring from is located in the same state and they’ve notified you that he’s ‘in-network’ with all regional insurance carriers.  All you have to do is send notice on letterhead to the insurance companies with your practice’s W-9, notifying him that he’s transferring to your practice with an effective date, right?  While this may work for some of the smaller, non-contracted, ‘tier 2’ payers, this is definitely not the case for most carriers.  While it may only take a few weeks to link your new provider to your practice with some payers, it could potentially take a few months, depending on several variables.  Does your practice have group contracts in place or does each provider need to be independently contracted with the carriers?  Was the provider previously affiliated with an IPA who utilized delegated credentialing?  Unless your practice is associated with the same IPA/delegated health system, the provider must be released from the delegated entity before he can be fully credentialed under your Tax ID.

If your new provider is coming from a hospital/hospitalist-based practice, he may not have needed to be fully credentialed to submit claims under that entity. So, while the previous practice is correct in communicating that he’s ‘credentialed’ with the carriers, they may not be aware that credentialing for your group practice means a much more thorough approach and could require additional time for the process to be completed.

If your provider is a Primary Care Physician, there are often contractual obligations that require a specific amount of notice a practice has to provide to the insurance companies. This enables the payers ample time to move the provider’s panel of patients to the new practice and update their directories accordingly.

Don’t underestimate the amount of time it can take to link an in-state, previously credentialed provider to your practice.  Make sure to provide your credentialing staff with as much lead time as possible to avoid any complications.