FAQ

Many physicians have lots of questions regarding the insurance credentialing process! Below are a few of the more common questions that we hear in our office:

How do I get started?
All you need to do is fill out one questionnaire and PMGI will take care of the rest!
How long does credentialing take?
Insurance credentialing usually takes around 30-120 days from the date you submit your application.
Will my In-Network status follow me if I move to another office?
Some insurance plans will require a full re-credential at each office location. Some insurance plans will allow a simple transfer location. We can assist you in determining what is needed for a transfer of location.
Am I able to use the seller’s information to bill after closing while I am waiting for my credentialing to be completed?
Technically no, you should list the treating doctor as the provider on the claim form. With the exception of Medicaid, insurance credentialing is provider specific. On an claim form there is a location for the billing entity that includes the tax ID number, NPI2, Billing name and address. There is a second location for providers (treating doctors), license number and personal NPI number. The insurance company will base reimbursement on the provider listed regardless of what billing entity and tax ID number are provided on the claim form.
How do I manage to bill out-of-network with some insurance plans the day I close on my new practice?
Unless a patient has no out-of-network benefits, you will be able to bill as an out-of-network provider for all treatment rendered after closing. You can write off the difference between the out of network price and the contracted price so the patient does not see a difference in their out-of-pocket cost.
Is it true that big group practices and corporations have more leverage in negotiating fees?
No. In fact, it is more challenging to negotiate higher fees for multi practice location businesses. Insurance companies will grandfather the entire office into the lowest fee schedule contracted with the group. There is greater leverage in negotiating fees as a solo practice.
Can I be in-network at one location and out of network at another location?
Yes and no. Some insurance contracts force the provider to take the insurance plan at any location.
Can I be out of network and my associate be in-network?
Yes. You can set up an associate as an in-network provider for any insurance plan and maintain out-of-network status under the same entity. Many clients find it helpful to bill under a separate tax ID number to make this billing process smooth.
Why shouldn’t I do my own credentialing?
PMGI and our amazing team have the knowledge, expertise and contacts to do your credentialing quickly and correctly.
Will I be notified of any issues in the insurance credentialing process?
Yes, we will notify you of any issues. We will also work with you to get any issues resolved as quickly and easily as possible.

If you have a question that hasn’t been answered above, please give our office a call. We’d be happy to help educate you in the insurance credentialing process.