Credentialing New Clinicians to Your Group Practice

Are you looking to have clinicians take insurance in your group practice? If so, you may be wondering how to start the process; what to do first, who to contact, what insurances to panel with, or how to actually panel with insurances (as a group or individually). Insurance credentialing is often the bane of many clinicians’ existence, from misplacement of documents from insurance companies to long wait times before getting paneled, to dealing with participation denial. Let’s take a look at some of the main questions group practice owners have about paneling new clinicians.

  1. How do I figure out which insurance companies to panel with? Start with asking local providers what insurances they are taking, the pros and cons of that insurance company (i.e. their rates, ease of sending claims, promptness of payment, etc.). Decide what is important to you regarding an insurance company and make sure to ask a potential insurance company about it. Your best bet is checking with local providers, or going to Psychology Today and searching providers in your area and seeing which insurances they take.
  2. Should new clinicians panel individually or under my group? And for that matter, should I set up a group contract with the insurance company? So, this depends on a few things. Some insurance companies allow group contracts, and some only allow individual contracts. This may be the deciding factor. For example, in Illinois, United Healthcare allows you to have a group contract once you have 5 clinicians, Magellan allows group contracts with just one clinician, and Cigna doesn’t allow group contracts. What’s important is that your clinicians credential using your group practice NPI-2 and Tax ID, not their social security number or under their name only. Doing so will result in them receiving checks in their name and you having to chase it down from them. You want checks to go to your business, so that you can manage that and pay your clinicians from that. The best way to ensure that is that they fill out a w9 with your practice name, TIN and address, so that insurances know to send checks to your business. A benefit to applying as a group (if it is possibly) is that you can negotiate rate increases more easily than a solo provider. Also, the process for adding clinicians is easier and less time consuming if you are a group (you just “add” them to the group) versus everyone individually applying. The potential drawback is that if a clinician wants to leave your practice, they will essentially have to restart the whole paneling process if they are paneled under your group versus if they are individually paneled, they can often just add a new location and delete your practice from their contract (although I have seen a few companies who still make clinicians panel all over again for new practices).
  3. What do I do once my clinicians have completed their application to participate? The most important thing is that they verify with the provider relations department that they received the documents. You would be surprised (or not!) by how often things get lost in transit and never reach the right department or person. I have clinicians check within a week by calling or email the provider relations department to verify they have received their credentialing paperwork. After that, I tell clinicians to check each month to make sure that they aren’t missing any documents or need anything more from you. Often, something simple like “Are you ADA accessible,” or “What are your office hours,” are the things that stall an application.

My one suggestion would be to put together a credentialing packet, with your business information that clinicians would need to apply, like your practice and remit address, TIN, NPI-2, phone and fax number, a completed w9, how to apply for a CAQH number (with a link to the website), how to apply for an NPI (with a link to the website), and a list of the insurances you would like them to panel on, along with any provider relations contact phone number or email, and a link to the application on their website since most have an online application. This makes the process easy for incoming therapists and reduces the amount of times they contact you for information!

Although credentialing can be a hassle and takes lots of time, many practices are rewarded with many new clients by using insurance. If you need help with the credentialing/paneling process, a great resource is Danielle Lapidus at Be Your Own Biller. Good luck!

Credentialing New Clinicians to Your Group Practice

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MAUREEN WERRBACH
Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here:
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2018-10-02T16:04:27+00:00 By |93 Comments

93 Comments

  1. […] you are just starting using insurance with your group practice, you may find this article helpful on paneling new clinicians in your group to insurance. You can also visit Be Your […]

  2. Kiran Mishra January 16, 2017 at 2:53 pm - Reply

    What is your advice on taking on clinicians who are already in network with an insurance company solo, who you are transitioning to your group, and now need to update their info so the group gets paid rather than the practitioner? Thank you!

    • The Group Practice Exchange January 17, 2017 at 12:25 am - Reply

      Hi Kiran,
      Thanks for reading and reaching out! I’d like to say a few things. One is, ask them why they are going into your group after having been solo, and what their goals are. The last thing you’d want is to go through the work of adding a clinician who had difficulty growing their own practice, who then fills up at your practice and leaves! There are many who decide that solo practice owning is not their cup of tea, and if that is the case, then here is my second thing. It is much easier to panel someone who is already paneled solo (usually). It also tends to take much less time to get them credentialed with your group. All they would need to do is contact network rep at the insurance company and let them know they would like to add a second practice, with a new tax ID and group NPI number. THEN, after that has gone through, they can delete their primary practice if they are done. Do not have them delete their solo contract first though, as that essentially puts them in the position of reapplying all over again. Also, make sure that they update their CAQH info to include your practice. Good luck!

  3. Ronnette Ballard June 30, 2017 at 5:06 pm - Reply

    What if the “solo, already in network clinician” wants to add my group as a new practice location but still practices part-time at their original location and needs to keep that info on file with the panel. My group is “not” on the panel to which the solo clinician belongs.

    If the solo clinician adds my group NPI, Tax ID as a second practice location, can the group be paid?
    Can I have them add my groups banking info so funds billed under the group NPI can be routed to the group-business bank account?

    Thanks

    • The Group Practice Exchange July 3, 2017 at 1:20 pm - Reply

      Yep, you are absolutely right. You would have them add your location, TIN, and NPI-2 as another location, and you will be able to have them bill that insurance then. They will send checks to you. In order to have insurances to send EFT, you will need to complete that insurance’s EFT form, and then they will send payments via direct deposit to your bank.

  4. Krystal September 7, 2017 at 7:19 pm - Reply

    Thank you for this, so informative!! Question: What is the difference between using a group npi number with an insurance company and having a group contract?

    • The Group Practice Exchange September 8, 2017 at 8:21 am - Reply

      Hey! Good question. A group contract means that when your clinicians apply to that insurance, they can apply to be added to your contract. A group NPI (NPI-2) every group needs to get, whether or not you decide to have a group contract or have everyone be individually paneled. Does that help?

  5. tracy September 21, 2017 at 6:18 pm - Reply

    what if the incoming clinician is in network with a carrier but as as group practice we are not, how does the clinician still retain their status for contracted fees for their clients, while practicing at my group/facility.

    I.e …I’m only contracted with bcbs, shes contracted with cigna and wants her clients to be billed in network benefits, but my practice tin and npi is out of network.

    • The Group Practice Exchange September 22, 2017 at 9:21 am - Reply

      She will have to add your location (TIN and NPI2) to her contract to be able to see clients at your practice.

  6. Carol October 25, 2017 at 8:33 am - Reply

    What if I am going from a solo practice to forming a group practice. I already have the group EIN and am applying for the group NPI. Is it back to square one to get credentialed as a group or does it help that Ive already been credentialed as a solo

    • The Group Practice Exchange October 30, 2017 at 7:33 pm - Reply

      Hey! Each insurance company has different rules. Most of the time, you will have to reapply as a group, but it doesn’t hurt to contact the network representative for each insurance company. Sometimes they will send you the paperwork and tell you to email it directly back to them, making the process easier! Good luck!

  7. Carol November 16, 2017 at 7:18 am - Reply

    What if as a solopractitioner you are credentialed with panels but when you start the group you would like to see if oon clients and not being on panels could be possible? Cant you just provide superbills with the group npi and ein since the group has not been credentialed with any insurance panels?

  8. Chris November 17, 2017 at 8:47 pm - Reply

    This was very helpful. I just want to make sure I understand completing the W9 for an IC of mine. I cannot be labeled a group under United bc she is my first employee. So I am completing an individual application for her and it asks for a W9. Line 1: I put the name of my LLC? Her name/info is never on the W9, correct? This ensures payments are made to me and if she goes out on her own someday, she needs to update her W9 w/United?

    • The Group Practice Exchange November 20, 2017 at 10:14 am - Reply

      Hey! You’ll put your business name on line 1, leave line 2 leave blank, and then put your TIN and work address, and then have her sign the bottom. Correct, her name is not on any part of the W9 that you give to insurances.

  9. Becky January 15, 2018 at 9:03 pm - Reply

    I have a question. I am a BCBA and am credentialed under a group of physicians currently. The owner has decided to no longer have me bill under him and gave me 60 days notice. I know I have to get credentialed under my own name, which can be time consuming. Would it be faster to try to get credentialed under another group while I am in the process of solo credentialing?

    • The Group Practice Exchange January 22, 2018 at 8:32 pm - Reply

      Hi! It really isn’t much quicker to credential under a group. If your ultimate plan is to be solo credentialed, I would just go that route!

  10. Eileen Harris January 26, 2018 at 10:58 pm - Reply

    I am going from a solo psychology practice to a group practice in NY and plan on hiring 2 Independent Contractors. One of the ICs is coming from a school setting and is not credentialed with any insurance carriers. Before he can begin seeing patients and bill through my NPI-2, does he need to go through the credentialing process with each panel I am on?
    If that’s the case, then would it be a better idea to only hire ICs who are already credentialed with multiple insurance carriers? Also, is it quicker for them to credential under my group?

    • The Group Practice Exchange January 30, 2018 at 9:24 pm - Reply

      Hi! Yes, your ICs will all have to credential with your group practice information, even if they are already in network elsewhere. The only benefit to hiring clinicians who are already in network is that the time it takes to add them to your practice is a little less than if they had to completely credential. But either way, anyone you hire will have to do some work with the insurance company to be paneled with the insurances under YOUR group practice. Good luck!

  11. Jacqueline Smerdel February 4, 2018 at 10:58 pm - Reply

    Question: If I have a group psychotherapy practice that would be comprised of an experienced licensed supervisor and a few interns (post MA/S and working on their hours for licensure), can the practice be credentialed even though it has interns? CAMFT (California Association of Marriage and Family Therapists) indicated that the work interns do can be covered by insurance if the practice or corporation is credentialed. Is this true? We would be a corporation. The supervisor has her own credentialing individually, but the work done in this office should be paid to the corporation which would then pay the supervisor and interns.

    • The Group Practice Exchange February 8, 2018 at 8:17 am - Reply

      I’m not 100% sure on California’s specific rules (IL group owner here) and I’ve heard Cali has some interestingly different rules so I’d reach out to CAMFT to get clarification. Most insurance companies, though, whether in Cali or elsewhere, do not allow interns to bill (even if under a supervisor). Medicaid does, so you could do it through them. But managed care doesn’t. Good luck!

  12. Emily February 7, 2018 at 11:24 pm - Reply

    Thanks for the info! I am currently paneled with Aetna and BCBS with the group practice that I work at. I just recently started my own solo side thing and wanted to be OON completely. Can I still do this? I’m other words- I would be in network with the group NPI but OON with my own EIN. Any suggestions or help would be awesome!

    • The Group Practice Exchange February 8, 2018 at 8:14 am - Reply

      You should be good to go! You may have some issues, but all it will take is calling the insurance and having them reprocess the claim as OON. I’ve seen this issue with Aetna, but not BCBS. Good luck!

  13. Lindsay Waxler February 15, 2018 at 8:02 pm - Reply

    Hello,
    I am a sole proprietor, acupuncturist that is in network with BCBS, CIGNA, and AETNA. I work 2 days a week in my acupuncture practice, and will be working 3 days a week for a large therapy practice as a mental health counselor. The therapy practice wants to also add acupuncture but is not credentialed to do so. The CEO has asked me to add their group practice to my ceedntialing, so they can bill insurance under them, for acupuncture services. They would also have another acupuncturist working there. Is this even possible and could this somehow negatively effect me and my acupuncture practice? I want to protect myself and I’m not certain I’m comfortable with this. Any suggestions or thoughts?

    • The Group Practice Exchange February 18, 2018 at 7:07 pm - Reply

      Hi Lindsay, here are my thoughts. If they are credentialed with insurance companies, they can add you as a provider on their group panel. If they are OON with insurances, then you CAN add an additional location to your contract. You will need their tax id and npi2 to do this. They will still not be able to see clients with those insurances, but you will be able to. You will just want to make sure that you are adding it as a separate location and Tax ID, so it shouldn’t then affect your business credentialing in your solo practice. Hope that helps!

  14. Charles March 22, 2018 at 10:22 pm - Reply

    While I am waiting for a new ic in my grouo practice to become credentialed what do I do with that person for three months until they are finally credentialed and can see clients? Thank you.

    • The Group Practice Exchange March 24, 2018 at 8:50 pm - Reply

      Hi Charles, most group practices check with their insurance contracts to see if their clinicians waiting to be paneled can see clients with that insurance OON while they are in the credentialing process. If so, they may bill OON at a reduced rate at the cost of the in network rate for that insurance to help the client out. Other options are requesting single case agreements for clients, getting the clinicians paneled with EAPs (typically you can get them in immediately or within days). Some insurance may retro date the credentialing date so that they can start seeing clients and hold billing until they’re in network and insurance will pay then. In this case, I would first check with each insurance to see if they retro date the credentialing date. More often than not though, the waiting period of a few months is the cost of taking insurance. Most group practice owners just have to wait it out for the most part. Good luck!

  15. Rick March 28, 2018 at 5:30 am - Reply

    Thank you for this very informative article. I am getting ready to graduate with my MA in mental health counseling and presently conducting my job search. One group practice that I’m very interested in is only self-pay, but considering changing that sometime in the future. They have said that they’d be open to having me get paneled and take insurance while they figure out what they want to do overall. In other words, they wouldn’t have a problem with me taking insurance even if the other four therapists don’t. I live in Illinois and I was hoping to get paneled with BCBS and Aetna. Is this legal and ethical? And would my status as an LPC impact the answer? I would be their employee (W2). Thanks so much for helping us all navigate these tricky situations.

    • The Group Practice Exchange March 30, 2018 at 7:48 pm - Reply

      Hi Rick,

      Great question! So as an LPC in IL (where Im located too!) Aetna and BCBS are the only two insurances LPCs can be one. It is definitely legal and ethical to panel with them as long as YOU are the one paneling with them and not just billing under a fully licensed therapists’ license. Once you are paneled though, you will need to “bill under a supervisor” and that person will need to be in network as well. This will still show you as the rendering therapist, but because you are not fully licensed yet, the insurance will want to know who is supervising you. I am almost positive that that person will need to be in network too, since they would be showing up on the claims too. The potential issue I see on the group practice owner’s side is that billing may get a bit messy on their end for those who are out of network. Sometimes insurances bypass or miss that some are in network in a group and some are out of network, and so the group owner or their biller may come by some small annoyances with having to correct some claims. One suggestion I would make is to make sure that when you do panel, that you do so individually and make sure not to sign a “group contract.” Hope that helps!

  16. Sharon April 4, 2018 at 7:45 am - Reply

    Hi I am an independent contractor in NJ and have an agreement with another llc. (Counseling practice). They do billing for me and use my llc name. Right now I have an NPI 1 number under my social sec number but I’m wondering whether or not I need an NPI 2 for billing purposes with insurance companies.

    • The Group Practice Exchange April 6, 2018 at 1:55 pm - Reply

      If you are an IC you will be billing under your NPI1 and THEIR NPI2. If you have your own solo practice, that’s when you’ll need that NPI2 so that claims go to your business. Hope that helps!

  17. Neelam Jain April 21, 2018 at 1:14 pm - Reply

    Hi. I am credentialed with many insurance companies as part of a large group practice under their contracts. I am going out on my own but established my company as a PLLC. Do I call the insurance companies to give them my NPI2 and tax id to move my credentialing over or do I need to apply for all new contracts because I established as a PLLC rather than as a solo practitioner?

    • The Group Practice Exchange April 23, 2018 at 9:32 am - Reply

      If you are credentialed under their group contract, depending on the insurance company you may have to completely re-credential individually. Being a sole prop or PLLC doesn’t matter in the case of having to recredential. If the group practice has clinicians individually credentialed under their group practice name (different that an actual group contract-not all insurances have group contract abilities) then you can add another location, TIN, and group NPI and it will take less time than applying all over again. The best bet is to ask each insurance company individually. Unfortunately they don’t have the same processes. Good luck!

      • Neelam Jain April 23, 2018 at 10:23 am - Reply

        Do you know of any service I could pay to have them move all my insurance contracts and help with recredentialing if needed?

  18. Neelam Jain April 23, 2018 at 10:01 am - Reply

    Thank you! Does TherapyNotes verify benefits? I don’t think it does but I wanted to confirm that.

  19. Donna May 6, 2018 at 7:39 pm - Reply

    Hello. I am an LCSW (Clinical SW) and LCADC (Clinical Alcohol and Drug Counselor) in New Jersey. I currently have a part-time private practice where I work with Out-of-Network Insurance only. I was hired to work at a medical practice and provide mental health and substance abuse assessments for their high-risk patients. However, they want me to get credentialed under the insurance panels that they work with. I am concerned about the insurance companies paying me in-network fees at my practice once I am credentialed. Can you suggest if I should use my own NPI at the medical group’s practice and their tax ID?

    • The Group Practice Exchange May 7, 2018 at 8:22 am - Reply

      It isn’t unheard of to have an insurance company reimburse in network if you our out of network in your own group but in somewhere else. The way to be able to work through this (you still may have to correct some claims in your solo practice but you’ll be able to correct them if they reimburse in network) is to credential under their group rather than individually. use their TIN and NPI 2 and your NPI 1. Good luck!

  20. Sharon May 7, 2018 at 11:44 am - Reply

    Good morning, this article has been extremely helpful! Thank you so much for your kindness in passing along this information! My question is, I do medical billing for therapists in private practice and so far, I only have solo practices in place. I have been asked to do billing for 2 therapists who are leaving a large group practice and forming a 2-person group (we are in Illinois). They would like to see clients at their present location right up until they move (if that’s even possible) so I’m thinking that July 1st may be a reasonable start date. I am in the process of changing over their information with all of the insurance companies they are credentialed with and CAQH. However, CAQH just informed me that they can only be registered with ONE NPI number in order to get paid. I have been putting their new NPI2 and new EIN number on all of the insurance applications…how do I transition them so that they can still be paid by their old practice?

    • The Group Practice Exchange May 8, 2018 at 7:59 pm - Reply

      Hey! You’ll want to make sure that they are adding a location and TIN and NPI2 of that location, not replacing the location they are currently at. Once they leave, then they can remove the first location.

  21. Goldie Rabaev May 15, 2018 at 7:30 am - Reply

    Hello… thank you for the article it was very helpful my question is can LSW or an LAS be in the world with an insurance plan under a group NPI and tax ID or do they have to be a fully credentialed clinician?

    • The Group Practice Exchange May 17, 2018 at 3:18 pm - Reply

      This is an insurance and state specific question. In IL provisionally licensed therapists can apply to be in network with BCBS and Aetna only. Other states/insurances don’t allow it. You’ll want to call the provider service line in your area to confirm!

  22. Kelly June 4, 2018 at 7:24 am - Reply

    Hi. I am wondering what it costs for the practice owner to add clinicians onto an insurance panel – in this case Cigna in NY. Thank you for all the information. I’d love to know more about contacting you for an informative session or workshop. Thanks!

  23. Clara June 4, 2018 at 7:20 pm - Reply

    I work for a solo practice LCSW in NJ who wants to hire a social worker to work with/under him. Neither of us have any idea on how to do this so I’ve turned to the internet. Am I correct to say he needs to 1st create a new TIN to create a group and then obtain a NPI2 for billing? And then I will have to work with the new social worker to get credentialed with the plans he already participates in? Thank you in advance.

    • The Group Practice Exchange June 5, 2018 at 10:20 am - Reply

      Yes those would be two steps he should first take. the social worker then can panel themselves with insurances and give the group practices TIN and NPI2 so they become paneled with the group. http://www.beyourownbiller.com has great advice on group practices and credentialing.

  24. Jake June 12, 2018 at 1:57 pm - Reply

    Hi. I’m a private practice MFT and I don’t accept any insurances in my private practice. I’m considering joining a group practice on a part time basis, however, that is contracted with numerous insurance panels. Is it legal in the state of NY to have a private practice where I don’t accept any insurance but also operate in a group practice where I do? I’m worried about instances where I see one patient in the group practice setting on Aetna, for example, and then bill another Aetna patient “out of network” in my private practice.

    Where can I find more info about the legality of this?

    Thanks so much!

    • The Group Practice Exchange June 18, 2018 at 10:05 am - Reply

      Hi Jake,

      The best place to ask is by calling the individual insurance companies. They all have their own rules so most things cant be generalized across all insurances. But it is possible to be out of network at one tax id ( business) and be in network in another business, as long as they are separate tax ids.

  25. Ron Davis June 18, 2018 at 6:04 pm - Reply

    what is difference Between Group contract and Facilty Contract?

  26. Ammar June 29, 2018 at 7:33 pm - Reply

    HI, I’m confused about credentialing. We have a group and three doctors works under the group. we have multiple locations. I called Aetna and they are asking me to provide a letter to explain what I need which is adding new addressed for the providers we have under the group and write down their information ( NPI, SSN, and License#) in addition to the group information ( NPI and EIN#) but what it doesn’t make sense they ask me to have W9 as well with individual providers information and their tax id ( which is here SSN). I don’t think this is correct can you explain?

    • The Group Practice Exchange July 11, 2018 at 8:53 am - Reply

      Hey! If you do what they are asking, then the claims will go directly to them. You should have your group practice TIN and your business name on that W9. You can fill it out once and just give a copy to all your therapists for when they credential.

  27. Akinola Mobolaji July 7, 2018 at 10:39 am - Reply

    Hi, I run an outpatient psychiatric services in PA and hoping to start drug and alcohol treatment. I want to hire a therapist/counselor that can be paneled with Medicare, Medicaid and other third party insurance. Can you please tell me what credentials the right candidates must have. Thanks.

    • The Group Practice Exchange July 11, 2018 at 8:52 am - Reply

      Medicare/medicaid aren’t my specialty. I know that counselors can’t be in network with medicare, so don’t go the LPC, LCPC route. A good resource would be http://www.beyourownbiller.com. Danielle knows all there is to know about mental health billing and credentialing.

  28. Cindy July 19, 2018 at 5:26 pm - Reply

    I am working with a provider that has been setup with his business under his ssn and so it is setup with an individual tax id for his practice. He also only has an individual NPI. He now wants to enroll for a group NPI so that he can add his wife to his group. She is also a provider. Would he have to also setup a group TAX ID to do this. He would rather not. Also, he is currently receiving payments from payers based on the individual tax id and individual npi. Will this rock the boat on payments and participation for his practice?

    • The Group Practice Exchange July 22, 2018 at 12:26 pm - Reply

      I strongly do not suggest having a tax ID be a social security number. He should talk to a business attorney or accountant, but most would urge him to shift to a TIN that is not his social. As for your second question, sometimes payments get messed up when switching from individual to group status on insurance panels, but we all do it. He may just have to call the insurance companies for the few claims that get messed up and they can fix it.

  29. Mahogany July 25, 2018 at 11:53 pm - Reply

    Hi! Thank you for sharing your wealth of knowledge. I currently have a group practice comprised of 3 LCSW’s. I am also interested in hiring MFT’s, Psychologists/PsyDs and LPC’s. Having a Psychiatrist on “staff” would be great as well. Do most insurance companies allow this variation of licensure under an LCSW-led group practice? I am located in Northern VA.

    • The Group Practice Exchange July 28, 2018 at 7:27 am - Reply

      The issue isnt the insurance companies. Each state has their own laws regarding whether one licensed type can hire another license type. I’d talk to an employment attorney in your area about this.

  30. Rona Wiedmayer September 14, 2018 at 7:50 am - Reply

    How long (hours) does it take to credential a therapist from start to finish)

    • The Group Practice Exchange October 17, 2018 at 1:24 pm - Reply

      It depends on the insurance company. Most are between 60-120 days from start to finish, although if the therapist is already in network from another practice, it is closer to 30-45 days to add a location.

  31. Shonn Broyles September 21, 2018 at 9:25 pm - Reply

    Hi! I am currently working in a group practice and I am.going to start my own practice a gew days a week. I will be billing the insurance companies using my NPI1 and TIN.I am.currently doing add a locations. Do I have to have a NPI 2 to complete billing in my sole practice or can I use my NPI 1

  32. Malia Davis November 1, 2018 at 11:00 am - Reply

    I’m glad you talked about how you usually tell clinicians to check each month to make sure they are not missing any documents that are needed for credentialing. I never knew that that was an important thing to keep doing because I thought once you submit the papers, you’re done with everything. I think I want to talk with a credentialing company to learn more about this and find out what other things I don’t know about the process because I’m nervous that I won’t get it right doing it all on my own.

  33. Patrick November 30, 2018 at 10:28 am - Reply

    Question-
    I currently work a full time job at a local hospital providing counseling services. I also have my small beginning group practice that I started growing this year. I just began the credentialing process for my group and have been rejected by a number of panels and currently only accepted by one. Can I use my credentialing status with the hospital to help gain credentialing for my group practice?

    • The Group Practice Exchange December 3, 2018 at 6:22 pm - Reply

      Hi! You may be able to with a some insurance companies. Each insurance has a different set up and rules for this. I would contact each one and ask if you can add a new location and Tax ID/NPI2. If they can, it will likely be the way to get in if they are closed.

  34. Megan January 20, 2019 at 2:29 pm - Reply

    Do you know if a current employer would be notified if I start credentialing as a private practice?

    • The Group Practice Exchange February 2, 2019 at 4:52 pm - Reply

      If they control your CAQH profile, then typically when a new insurance pulls info from your CAQH profile it sends an email to the CAQH administrator. If they don’t, then they aren’t notified as far as I know from the insurances we have had experience with.

  35. Hallie February 16, 2019 at 1:50 pm - Reply

    We started a non-profit that provides counseling to veterans. We have a TIN and NPI2 for the non-profit. The counselors we will be hiring are both credentialed with TriCare and each have an NPI1. They use the TIN number of their current employer.

    Does the non-profit need to become credentialed with TriCare to bill and receive the funds for services provided by these counselors or can the counselors just use add the non-profits NPI2 and TIN to accomplish the same end without the need to credential the organization?

    Would they also include the non-profit information on the w-9?

    • The Group Practice Exchange March 8, 2019 at 1:15 pm - Reply

      I do not know the specifics about Tricare. Each insurance has their own rules when it comes to the process for getting in network and what that looks like. Most insurances will want your business info on the W9 so that payment comes to the business, and most insurances allow the group to be out and the individual clinicians to be in, as long as they list your business as a location they practice out of.

  36. Raphael February 21, 2019 at 4:46 pm - Reply

    I think this question came up before but I wanted to be sure I had it correct. I am paneled with a group (my group) at one location and typically bill under the group tax ID and NPI. I would like to maintain that but I also have a new contract possibility at a different location on the side that could be OON / full fee. Can I use my individual NPI and social security number as my TID to bill and not have to leave the panels?

    • The Group Practice Exchange March 8, 2019 at 1:17 pm - Reply

      This is a hard one. A lot of people want to go around the insurance panels this way with one of their locations. The only way Ive seen it work is by setting up a completely different business with a new NPI and TIN, otherwise you will likely confuse the insurance companies and they may bill in network and bypass you trying to be OON in one location.

  37. Deneice February 21, 2019 at 8:32 pm - Reply

    What is the best way to change the tax id with insurance companies for a physician that is in a group practice but starting his own S-Corp. Do I need to get a NPI 2 for the S Corp? Will the s Corp need to be contracted with insurance companies?

    • The Group Practice Exchange March 8, 2019 at 1:18 pm - Reply

      Are you billing under the group practice or the clinician. If under the group practice, then the physicians’ NPI 1 is the only thing being used on claims. If he is billing under his name and TIN right now, then when he changes his TIN he will have to send a new W9 to insurances with the updated TIN.

  38. Nicole February 22, 2019 at 6:05 pm - Reply

    Hi there. Thank you so much for all of this information. I have read through some of the comments but am still a bit confused so asking for clarification. I currently work in a practice and am in-network with several insurance companies through their group tax id and my personal NPI. I am now practicing part time in another clinic that is out of network. I made a PLLC so I can have my own personal taxID. Do I also need a second NPI to be out of network in the second practice but remain in network in another practice, or is a separate TaxID but with the same NPI sufficient?

    • The Group Practice Exchange March 8, 2019 at 1:21 pm - Reply

      You *should be fine if you are using a new TIN at the second location. I have, though found that a few insurances dont care. We recently had an experience, where we are out of network with Aetna as a group practice. An employee of mine was in network at an old group practice she worked at, and although our group is OON, they processed all the claims INN and said it doesnt matter that we are out, and that her contract carries over wherever she is. Nice, right?

  39. Kat April 4, 2019 at 5:52 pm - Reply

    I recently got hired on to a private practice as a contractor. I am very new to private practice. I am an LCSW. Is the owner legally able to bill insurance using her NPI information for clients that I see?

    • The Group Practice Exchange April 26, 2019 at 9:58 am - Reply

      No you need to get credentialed under your own NPI (as rendering NPI) through the group with their tax ID and group NPI2 (billing NPI). There are a few insurances in some states that allow billing under a supervisor but that is only for intern or provisional licensed (like LSWs) not for fully licensed therapists. Many groups do this, and it is fraudelent billing to bill under someone else’s NPI number for a fully licensed therapist. Great question.

  40. Kathi April 8, 2019 at 4:14 pm - Reply

    I was recently hired as a Billing Mgr for A FQHC to bring their billing in-house….
    The previous billing has made it near impossible for me to get any answers during the process, so hoping you may be able to help a bit?
    There are about 24-27providers, billing under a group practice….with CAQH if they provided me with a list of all providers and their CAQH #’s so with credentialing and uploading to the new clearing house , how exactly should this be done?

    • The Group Practice Exchange April 26, 2019 at 9:57 am - Reply

      I’m not fully understanding your question. Can you rephase that for me? If those 24-27 providers are already credentialed, they’d already be set and you dont need to do anything further.

  41. Aaron April 8, 2019 at 11:56 pm - Reply

    Hello, thank you so much for such excellent Information. I am very interested in joining a group practice in the future. I Interviewed for one last year, and I feel I didn’t get it bc i wasnt independently credentialed. Do insurance companies allow lpc’s to maintain credentialed status, if the lpc doesn’t utilize it fairly quickly? In other words, should I get credentialed prior to restarting my search?

    • The Group Practice Exchange April 26, 2019 at 9:55 am - Reply

      Hey! You wont be able to credential if you dont have a place of employment to credential under, so unless wherever you are working now will allow you to credential with insurances, there isnt really a way to “prep” before being employed in a private practice.

  42. AC April 20, 2019 at 7:40 am - Reply

    Thank you for this information. I started contracting for private practice and joined a group practice in which we starting the credentialing for insurance in CA. My situation is I want to start in the group practice and eventually on the long run I would like to move on my own once I know what I am doing. In which hand I would then have to apply for solo practictioner correct? Also, I am in bordering counties therefore would like to remain in the group practice in one county and start solo on the other county. Can this be done ?

    • The Group Practice Exchange April 26, 2019 at 9:53 am - Reply

      Yep, you’d have to add a new location and tax id. If you are credentialed in the group practice as a group (some insurances do group contracts, and some dont so groups then credential each therapist individually) then you will have to do a whole new contract. If you are individually contracted through the group then you would just add a new location and tax ID when you have your own thing set up.

  43. Shenice April 23, 2019 at 8:23 am - Reply

    I have one question not sure if it has been asked. If a provider is already in network with an insurance company like Aetna or BCBS. once the link letter has been sent and the provider has been added to the group does it require a new contract?

    • The Group Practice Exchange April 26, 2019 at 9:52 am - Reply

      If you have a group contract and you link the new provider (who was already in network elsewhere) then they’ll be set and not need to sign a contract, since they are being added to your existing group contract.

  44. Nea Stamps April 30, 2019 at 5:09 pm - Reply

    Hi, clarified is needed….do I need need to apply for a new TIN if I am transitioning from solo to group practice?

    • The Group Practice Exchange May 7, 2019 at 2:55 pm - Reply

      Hi! It depends on if you are restructuring your practice entity. For example, I went from a sole prop to an S Corp when I started my group and had to get a new TIN. I’d talk to a business attorney to discuss your options.

  45. Tina May 16, 2019 at 2:23 am - Reply

    I have a question regarding IC billing under Group’s tax id and NPI. Do most groups have access and maintain ownership of notes in the even they are audited by an insurance company and have to provide documentation of services, medical necessity, and proper documentation of records. Should Groups w/ IC maintain copies of all medical and financial records once a IC leaves a group practice? If audited do they audit the IC who has an individual contract with an insurance company billing under a group or do they hold the owner of the tax ID responsible for any repayment of funds?

    Your article and response to questions are very informative.

    • The Group Practice Exchange June 15, 2019 at 6:58 pm - Reply

      Notes are a part of the group practice. If an insurance does an audit, they will be auditing under the tax ID, so you will want to make sure you have all of that. Clinicians can have clients sign a ROI to release a copy of records to another practice if they leave, but a copy should always stay with you.

  46. Ashley May 16, 2019 at 5:15 pm - Reply

    Hi! I am a LICSW I have my own private practice but looking to hire a Social worker to help out with some clients, initial intakes or group therapy. I am credentialed with Medicaid and managed care plans in my state. Is it possible to hire someone who is not licensed as myself. I am getting lots of applicants who just have masters degree in social work. Is it possible for them to see patients and have them bill under my NPI since they obviously wouldn’t be credentialed with insurances?

    • The Group Practice Exchange June 15, 2019 at 7:00 pm - Reply

      This will depend on your state’s laws. Some states have rules on license types supervising or managing other license types. I’d check with an employment attorney in your state. As for the second part of your question, I am not sure about Medicaid, but most insurances require you to have them credentialed. In IL as I am writing this, unlicensed therapists (interns) can bill under supervisor without being credentialed for BCBS only. I would check with each insurance you are thinking about doing this with, as they all will have their own rules.

  47. kristina n. June 5, 2019 at 12:51 pm - Reply

    Hi! thank you so much for all your information and answers. Here is my question. We are a NY neurosurgery practice. our tax id and dr #1 we’ll call him is in network with all insurance companies, dr #2 joined the practice within the last year or so as an out of network provider under our tax id #, i called all insurance companies we bill and went through the process to add her to tax id but as out of network, unlike dr #1. here’s the question, when we are billing dr#2 who is out of network but billing her under the tax id the in network doctor uses will the claim be paid based on the tax id showing there is an in network provider under the same tax id or process under the npi of the rendering, out of network doctor listed on the claim? also, in box #33 of the hcfa 1500 form, billing provider info, we have our practice name listed and the group practice npi is printing. this doesnt seem right. if the provider is out of network do we want our practice name in box # 33 but the npi as the out of network doctor’s npi so its processed correctly, out of network…? thank you!

    • The Group Practice Exchange June 15, 2019 at 7:04 pm - Reply

      OK, so this will depend on each insurance company. I have had an insurance company who automatically bills in network because our TIN is in network even though the individual therapist isn’t. I have had the opposite happen as well. Unfortunately this question isnt easy to answer. You’ll have to call each insurance to see. Box 33 should be the rendering provider (the therapist) not your group. Your group practice npi should only go in the service provider box.

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