Credentialing & Contracting for Nurse Practitioners and PAs: What You Need to Know

Credentialing and contracting mid-level medical providers can lead to unintentional billing compliance problems if the person handling the process doesn't understand what they are doing or asks the right questions. Each insurance company has different requirements for mid-level providers, and not being aware of these differences could pose a threat to the business. The video discusses the various options for mid-level credentialing and contracting and explains the potential negative consequences of ignoring the guidelines.
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Hi there! My name is Jennifer. Over the last 15 years, I've gained much experience working in the medical field in various roles. Through my experience, I've seen many medical practice owners make mistakes in running their businesses. That's why I created this channel - to help medical practice owners avoid these common pitfalls. I aim to promote growth and success within the private practice world of medicine. Healthcare has become too standardized, creating many unnecessary challenges and demands.
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[@zahoorullahminhas8533]

Thank you for sharing this. Best Regards

[@navigatingthebusinessofmed8251]

Thanks for visiting

[@zahoorullahminhas8533]

Dear Jennifer, I hope this comment finds you well. I wanted to take a moment to express my gratitude for the knowledge I’ve gained from your videos on credentialing. Your insights have been incredibly valuable, and I appreciate all the effort you put into sharing this information. Currently, I am working with a Nurse Practitioner ( DNP, PMHNP Title: PMHNP) specializing in Psych/Mental Health, and I need to enroll her with MaineCare (Medicaid ME) and Optum. She requires both individual and group contracts. Could you please advise whether it is necessary to credential her with Medicaid ME before proceeding with her credentialing with Optum? Thank you in advance for your assistance. Best regards, Zahoor Minhas

[@navigatingthebusinessofmed8251]

@@zahoorullahminhas8533 hi there and thank you for your kind words. I’m so happy to hear my videos have been helpful to you. I would recommend initiating credentialing with the payers ASAP while simultaneously asking for an enrollment contract. You can always let the other insurances know the Medicaid credentialing is in process. Some may require it to be completed before they move forward with their application for their Medicaid lines of service, but at least it would be on its way to completion when that happens. Good luck and I appreciate the support!

[@zahoorullahminhas8533]

@@navigatingthebusinessofmed8251 Thank you so much.

[@achiveatthe1percent]

Hi, I need to discuss a case We have a multi location practice, we have MD how is the partner in the business and the group have a group txt ID and NPI under his name and all the other providers are enrolled under the group and now we are planning to send claims to the insurance, Do the owner provider has to sign all the encounters or any of the rendering provider can also do that!

[@navigatingthebusinessofmed8251]

Hi and thank you for watching my videos! It depends on multiple factors. The biggest one is if you have an MD who is listed as the mid-levels (PAs and NPs if you have them) supervising doctor at their boards and what the state’s requirements are for them. It also can be depending on your supervising agreement with the mid-levels and the doctors internally. The insurances in your area may have their own guidelines for this too. You would need to check with each. As far as for billing, if all are individually credentialed and enrolled under the group contract as individuals then you can bill under them and they can sign their own notes for claims purposes. Good luck!