Oct 23 2007
Insurance Credentialing
I received a call this evening from a fellow NP who is a practice owner here in WA. Her clinic is a combination of urgent care and primary care. She recently hired a couple of NP’s and has been working at getting them credentialed with insurance companies. Two of those applications have taken a new, and very backwards turn.
You see, here in WA State, we are independent. We don’t have problems getting credentialed as a rule. However, apparently both Premera Blue Cross and First Choice Network are now requiring that NP’s that do not have hospital privileges, have a signed document from the physician who will be admitting their patients.
Not only that, but it has to be a new document, on the insurance company letter head, and signed EVERY three months for EACH NP.
Both my friend and I are credentialed with these companies and have never heard of this before, so it appears to be a new requirement.
The implications to this “ruling†are potentially huge, and definitely will put up a barrier to practice. My friend plans to contact the insurance commissioner’s office to discuss this issue further.
Has this issue surfaced for anyone else, Washington State or otherwise?
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I was self employed in an Internal Medicine clinic in Renton WA. In order to meet the requirement for a physician to admit patients for inhospital managment I set up my own contract with South Sound Inpatient physicians. The MD who I practiced with also used their services. I made it a point to have my own contract because I wanted to establish the fact that I was a separate entity and not practicing “under” the physician. I would have patients only admitted to hospitals that had an inpatient service set up that you could contract with. Hospitals need patients, Hospitalists need patients. Don’t assume you can be pushed out of the loop…contract directly with those who stand to benefit from your business. If the insurance companies want to make it difficult for awhile, they too will tire of collecting the signed form quarterly.
Cindy
With my recertification with First Choice recently, I did get a call stating something similar to the NP that contacted you. I called the company and notified them that I refer pateints to hospitals that have hospitalists on staff and they contact me with info regarding admits and discharges. They had me fax them a letter to that effect and renewed my contract w/o any more trouble. I hope this helps anyone looking for answers on this matter.
Would you share the basics of what your contract consisted of. I too have a MD that has agreed to admit my patients as hospitalists. I was unaware that a contract was needed.
Thank you,