Credentialing Tip - Crossing State Lines

We have been receiving many inquiries related to the nuances of adding a practice location or acquiring a practice outside of your current state. This is a relevant topic and one which we addressed in our Smarter Credentialing webinar last fall.

Some reminders about adding another state to your practice:

  • Your practice may need to register with the new state as a corporation and must meet the requirements in that state for ownership of the practice (corporate practice of medicine) and the registered type of corporation.  
  • New Medicare and Medicaid groups will need to be established for your Tax ID Number in a new state.  Individual enrollment applications for each group member being linked to the group as well as group linkages should accompany the group request.
  • If your Tax ID Number is not known in the new state, you may need to establish a group contract.  Your local plan representatives should be able to connect you with their counterpart in the new market.
  • You will be working with new Medicare, Medicaid and Exchange plans.  If this is an acquisition, the plan list of your new practice will provide the plan list.  If you have never operated in that state, a list of approved plans will be available under the local health department website.  You may have to search a bit.
  • Update CAQH and NPI profiles for the practitioners impacted.
  • Get started early.  The process may take some time. If this is an acquisition, financial projections should allow for a realistic cutover date while having the ability to continue under the existing group until key credentialing is in place.  

Whether you are a solo practice, a large group or a hospital-based practice, MDeverywhere can manage your health plan enrollment needs. Medical practices have long realized that efficient credentialing is key to realizing all available revenue.  The ability to bill and collect on every dollar is critical at a time when most practices are under the dual pressures of reduced reimbursement and increased practice expenses. In addition to lost billing, appropriate credentialing can be critical to maintaining and growing your patient population as patients look to use only participating providers to avoid out-of-network fees.

Efficient enrollment in your region’s plans will help you retain your current patients, grow your practice while reducing write-offs and collection headaches. Having our staff manage the enrollment process and your ongoing re-credentialing needs will enable you to re-allocate office personnel to revenue-generating tasks within your practice.

We have routinely assisted clients in reducing credentialing denial rates to less than 2%. Contact us to find out how a partnership with eMDs can help you reduce credentialing-related denials and manage your provider enrollment process efficiently and cost effectively.