Mar 16, 2020
3
1
Status
  1. Optometry Student
I am a new grad and just got my first job! I am hired as an employee at a retail location and I am trying to figure out this whole insurance thing and I am admittedly very naïve. I have my NPI number.

1) Does being an employee mean that insurance is processed through my hiring OD's credentials which is why I don't have to be credentialed at time of hiring? I am confused about the logistics of how this works and an ELI5 explanation would be appreciated.
2) What benefit is there to the employer and myself if I have my own credentials as an employee? (Hiring OD wants me to eventually be credentialed with a couple of companies)
3) I've read that applying for CAHQ is the way to go for easy credentialing - do any of you have experience with this?
 
Jan 2, 2010
42
9
Status
  1. Optometry Student
I am a new grad and just got my first job! I am hired as an employee at a retail location and I am trying to figure out this whole insurance thing and I am admittedly very naïve. I have my NPI number.

1) Does being an employee mean that insurance is processed through my hiring OD's credentials which is why I don't have to be credentialed at time of hiring? I am confused about the logistics of how this works and an ELI5 explanation would be appreciated.
2) What benefit is there to the employer and myself if I have my own credentials as an employee? (Hiring OD wants me to eventually be credentialed with a couple of companies)
3) I've read that applying for CAHQ is the way to go for easy credentialing - do any of you have experience with this?
1) Each provider MUST be credentialed by every plan (only exception is some short-term fill-in work). You'll either get reimbursed as a non-network provider (lower rate), not reimbursed at all, or fraudulently bill under someone else's credentials. For both NPI & tax ID #'s , there is a provider # and a billing # (can be the same if in a sole-proprietor setting)
2) see #1
3) A lot of carriers use CAQH (centralized credentialing service), but others will have their own credentialing. They can be a bear to get completed quickly. Be sure to save everything, because you may be asked to resubmit several times.

In most cases, it makes sense for OD's to form a personal professional corporation (need to apply for a corporate tax ID #).
Each employer will contract with your corporation to provide optometric care for them.
I'd suggest meeting with a good CPA to get set up.
 

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