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- Feb 24, 2009
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Hello! I am in the process of opening a solo psychiatric practice this summer and currently getting credentialed with some of the commercial insurers and Medicare. During this credentialing process, a blue cross blue shield agent said, "If you choose not to accept Medicaid Managed Care members, this would be for all health plans, not just for BC/BS. NYS doesn’t allow for providers to pick and choose what MMC policy they can and cannot accept, as it is all or nothing."
To my understanding, however, healthcare organizations also determine what plans they accept, and many physicians work for a variety of healthcare organizations, some of which do/don't take Medicaid. For instance, a physician may be credentialed with Medicaid and see Medicaid patients at a hospital for 3 days/week. However, that physician may work for a different healthcare organization for 2 days/week, an organization that does not accept Medicaid insurance. So, although the individual provider is credentialed in Medicaid, whether she sees Medicaid patients depends on the healthcare organization setting and its policies. (is this incorrect?)
My question is this - I recently formed a professional limited liability corporation (PLLC) that is independent of me and that I plan to bill through - it has its own NPI type 2 number, tax identification number, business accounts, etc. So, although I am individually credentialed with Medicaid and will continue to see patients with Medicaid when working part-time with the academic hospital, it seems strange that I would be required to accept Medicaid insurance while working at an entirely different organization (my PLLC). Any idea if it is possible to be individually credentialed with BC/BS and its Medicare and Medicaid plans but, for the group/PLLC contract, only have the PLLC credentialed with BC/BS and its Medicare plans? That is, can my PLLC be credentialled differently than me individually?
Thanks all! I tried to find the answer to this question on Reddit, this forum, and google but had limited success.
To my understanding, however, healthcare organizations also determine what plans they accept, and many physicians work for a variety of healthcare organizations, some of which do/don't take Medicaid. For instance, a physician may be credentialed with Medicaid and see Medicaid patients at a hospital for 3 days/week. However, that physician may work for a different healthcare organization for 2 days/week, an organization that does not accept Medicaid insurance. So, although the individual provider is credentialed in Medicaid, whether she sees Medicaid patients depends on the healthcare organization setting and its policies. (is this incorrect?)
My question is this - I recently formed a professional limited liability corporation (PLLC) that is independent of me and that I plan to bill through - it has its own NPI type 2 number, tax identification number, business accounts, etc. So, although I am individually credentialed with Medicaid and will continue to see patients with Medicaid when working part-time with the academic hospital, it seems strange that I would be required to accept Medicaid insurance while working at an entirely different organization (my PLLC). Any idea if it is possible to be individually credentialed with BC/BS and its Medicare and Medicaid plans but, for the group/PLLC contract, only have the PLLC credentialed with BC/BS and its Medicare plans? That is, can my PLLC be credentialled differently than me individually?
Thanks all! I tried to find the answer to this question on Reddit, this forum, and google but had limited success.