insurance panel/credentialing question

[vistaril]

Say a psychiatrist takes a salaried inpatient job with a hospital system. They then do the necessary credentialing things to make sure he gets reimbursed for his inpatient codes by whatever the area's main insurers are(blue cross, humana, united, etc) and Medicare/aid.

Then the psychiatrist starts up his own part time solo practice.

Does he have to do all the credentialing paperwork to get on insurance panels again for this private outpt work? What about medicare?

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[F0nzie]

My understanding is the credentialing process for your pp will be much quicker and less of a headache since those major insurances already have your information.

 

[michaelrack]

Agree for the most part, with Fonzie- although it depends on insurer. When I left academia, it was easy to get BCBS credentialing for private practice. For some other insurance plans, it was much more difficult. Generally it is easier for insurance companies that have relatively open plans.

 

[AZ Credentialing]

Yes with most insurers it will be easier as long as you do not let your present contact terminate. with some insurers - even if you are termed for only one day, you have to be initially credentialing as an initial provider. However if you are responsible and contact the insurers in advance - they can simply do a demographic change and you credentialing will stay current. This is for most plans though. If leaving a group or hospital, check beforehand to be sure the prospective ins. plan is currently accepting new providers in a given specialty - if they are not - that could prevent a provider from being able to participate as planned. Doesn't happen a lot - but it does happen.

 

[AZ Credentialing]

I just re-read my post - Apologies for the typo's - Been up for 36 hours.

 

[michaelrack]

Yes with most insurers it will be easier as long as you do not let your present contact terminate. with some insurers - even if you are termed for only one day, you have to be initially credentialing as an initial provider. However if you are responsible and contact the insurers in advance - they can simply do a demographic change and you credentialing will stay current. This is for most plans though. If leaving a group or hospital, check beforehand to be sure the prospective ins. plan is currently accepting new providers in a given specialty - if they are not - that could prevent a provider from being able to participate as planned. Doesn't happen a lot - but it does happen.

Agree, the more the plan needs providers in a specialty, the more likely they are to credential/renew you without a hassle. Psychiatry usually isn't too much of a problem. Doctors in a lucrative procedure-heavy specialties often have road-blocks thrown up in their way.