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Provider Numbers

 
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Provider Numbers - April 28, 2009 6:24:07 PM   
shahpt

 

Posts: 12
Joined: December 18, 2008
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Hi,

I'm planning to open up a new PT clinic in NYS. I know that we have to have the provider numbers to be able to participate with the insurance company. I also started the process; however, sometimes I get the wrong numbers and the wrong person who just don't know where to transfer me. I'm all confused with the procedure and the forms need to be filled out. I was wondering if anyone knows the easy way for this or has a procedure to get the provider numbers. Or may know any other important tips for new practice setting.

Any answers or feedback will be appreciated.

Thanks
Post #: 1
RE: Provider Numbers - April 28, 2009 11:32:52 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
Every insurance company will have phone numbers for "provider consultants" or "credentialing" or "enrollment."  You probably want someone in "enrollment."

(in reply to shahpt)
Post #: 2
RE: Provider Numbers - April 29, 2009 5:56:02 PM   
shahpt

 

Posts: 12
Joined: December 18, 2008
Status: offline
Hey Thanks SJ, but I know that they than see if there is a need for therapist and I may or may not get the provider number. How can we overcome this hurdle. Or do you think it will be a good idea to join a doctor and bill under his provider number? Any experience with that?

(in reply to SJBird55)
Post #: 3
RE: Provider Numbers - April 30, 2009 2:14:37 AM   
shahpt

 

Posts: 12
Joined: December 18, 2008
Status: offline
Here are my two cents and don?t hold me accountable to it cause my info may be out of date now: Accounts receivables billed under physiatrist?s provider number is physiatrist?s money, period. The billing will be done under the doc?s number, he gets the checks, and in some cases your name and license does not even go on the billing form depending on the insurance company. You will need to setup a fee per visit rate with the physiatrist so you can get paid. The only way this can be advantageous to you is if the physiatrist starts filing credentialing applications for you under his company name (doesn?t matter how his business is setup). Then when you will finally be in the insurance provider system, even if you are linked to the doc, you can then eventually break free by contacting the credentialing dept. and explaining to them that you are breaking free and setting up your own shop. This is what I know. I don?t know if this loophole is still doable. You can investigate and find out. Good luck. To get further feedback post this answer on rehab edge so it can get critiqued by more experienced business savvy PTs.  This is the msg. recieved by Faoompt.
 
Thanks Faoompt.

(in reply to shahpt)
Post #: 4
RE: Provider Numbers - April 30, 2009 3:44:51 AM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
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You don't need to have any physician file credentialing applications!  Do it yourself!  There is not a single need for a physician to be of assistance. 

If you need help THAT badly, hire and pay a consultant to do the paperwork for you! 

When you "break" free from the physician, you can't just continue to be a participating provider - you have to eliminate your relationship with the physician and stop the reassignment of benefits to the physician.  You have to create your own company!  Your own company will have to go through the process.  You can have your own practice and treat patients without any numbers.... if you believe you will be participating, you fill out the enrollment forms and most often you will be accepted as participating based on the date you sign the forms.  (Someone in enrollment can tell you if they are accepting providers.)  You just hold your claims until you have all your numbers and then send out a lot of claims and wait for a big check!

(in reply to shahpt)
Post #: 5
RE: Provider Numbers - April 30, 2009 1:59:23 PM   
shahpt

 

Posts: 12
Joined: December 18, 2008
Status: offline
you mean to say that I can see patients even before I'm enrolled with the insurance company? But what if I don't get enrolled for say 6-8 months? I tried calling copule of companies like megnacare, aetna, cigna and so on. They said they are not accepting any more individual therapist applications. They told me to keep calling them every month and some of them told me to keep filling the form everymonth to find out if htey are accepting any more applicants. In this case won't I be loosing money?

What if someone else files the application and I'm little late in filing application and the other person gets the enrollement and I'm left behind?

Is there a way to do it in a systematic way and not to loose money?

Do you know any website/s where I can keep checking the enrollement process. I asked the companies, they say their representatives can only do that not us.

any help will be highly appreciated as I really want to open up business but I'm overwhelmed with all these questions and confusions.

Thanks

(in reply to SJBird55)
Post #: 6
RE: Provider Numbers - April 30, 2009 6:05:20 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
If they aren't accepting, they aren't accepting.  Know the population in the area and the what most of the population has for insurance coverage.  As I said... have an idea about enrollment - if they ARE accepting, then you will be accepted on the date of your signature and you file your claims after you are considered "participating."

Enrollment would be the only entity in the insurance company that would know their business.  As what happens if you had a company - tax ID and wanted the company enrolled?  I have both a company NPI and my own personal NPI.

(in reply to shahpt)
Post #: 7
RE: Provider Numbers - April 30, 2009 9:52:26 PM   
shahpt

 

Posts: 12
Joined: December 18, 2008
Status: offline
Oh OK. Now I get it.

(in reply to SJBird55)
Post #: 8
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