WE RECEIVED TWO MIS NUMBERS THROUGH EMAIL SO CALLED TO GET THE CREDENTIALING STATUS. THE MIS 777883000 IS FOR THE INDIVIDUAL PROVIDER. THE MIS 600004983 IS FOR THE GROUP PROVIDER. THE REPRESENTATIVE SAID THAT THE APPLICATION WAS FILLED ON 03/01/21. INSURANCE INFORMATION, LICENSE AND RESUME ETC. WERE RECEIVED. THEY HAVE NOT PULLED THE CAQH YET. SHE ASKED IF WE HAVE RECEIVED THE CONTRACT PACKAGE YET? I TOLD HER WE HAVE NOT RECEIVED SO SHE NOTED DOWN THE EMAIL ADDRESS AND SAID THAT SHE WILL MAKE A QUICK CALL TO THE CONCERNED DEPARTMENT AND TELL THEM TO EMAIL IT TO YOU.
CALLED TO GET UPDATE ON OUR CREDENTIALING PROCESS AS WE HAVE SENT THE SIGNED CONTRACT BUT HAVE NOT RECEIVED A FEE SCHEDULE OR PROVIDER IDS YET. THE REPRESENTATIVE SAID THAT LAST UPDATE WAS ON MARCH 5TH, 2021. THE CONTRACT WAS RECEIVED AND THE CAQH IS COMPLETE. A CONFIRMATION EMAIL WAS SENT. BUT THE RECRUITER DIANA BURGOS IS NOT WORKING ON THIS CASE ANYMORE. SO THEY ASKED FOR OUR EMAIL ADDRESS AND SAID THAT THE NEW RECRUITER WILL APPROACH US FOR THIS.
CALLED TO GET UPDATE ON OUR GROUP CREDENTIALING APPLICATION. THE REPRESENTATIVE ASKED A FEW QUESTIONS TO FILL THE FORM AND SAID THAT SHE WILL SEND THIS FORM TO THE PROVIDER RELATIONS TEAM AND SOMEONE FROM THEM WILL REACH OUT TO US IN TEN TO FOURTEEN DAYS.
CALLED TO GET UPDATE ON OUR CREDENTIALING PROCESS. ACCORDING TO THE REPRESENTATIVE, THE LAST UPDATE WAS ON 03/05/21. THEY HAVE RECEIVED OUR CONTRACT THAT WE SIGNED VIA DOCUSIGN AND SENT. THEY CHECKED OUR CAQH AND SAID THAT IT SEEMS LIKE NO INFORMATION IS NEEDED FROM US. WE HAVE TO GIVE 3 MORE WEEKS BEFORE WE CALL AGAIN TO GET THE NEXT UPDATE.
CALLED TO GET THE STATUS OF OUR GROUP CREDENTIALING APPLICATION BUT THE REPRESENTATIVE WAS UNABLE TO PROVIDE THE STATUS AND GAVE THE EMAIL ADDRESSES THAT WE ARE ALREADY TRYING. SHE SAID THAT THERE IS UNFORTUNATELY NO OTHER WAY TO GET THE STATUS ON OUR APPLICATION OTHER THAN GETTING A RESPONSE AT THE EMAILS BECAUSE THERE ARE NO PHONE NUMBERS OR ANYTHING OF THAT SORT FOR THE CONTRACTING TEAM.
CALLED TO GET INFORMATION ABOUT THE PROVIDER ID 536856. ACCORDING TO THE REPRESENTATIVE. IT IS SOLO PROVIDER ID AND IS SHOWING OUT OF NETWORK. WHEN ASKED ABOUT THE CREDENTIALING APPLICATION THAT WE SENT, HE SAID THAT THE APPLICATION IS SHOWING UP IN OUR SYSTEM WITH THE SUBMISSION DATE OF MARCH 3RD, 2021. IT IS WAITING TO BE PROCESSED AND THE CREDENTIALING PROCESS TAKES 90 TO 120 BUSINESS DAYS.
CALLED TO GET THE STATUS OF OUR APPLICATION FOR GROUP CREDENTIALING OF OUR PROVIDER. THE REPRESENTATIVE INSTRUCTED TO SEND AN EMAIL TO ABHILCONTRACTING@AETNABETTERHEALTH.COM TO GET THE STATUS.
CALLED AT THE NUMBER (773)269-8984. TOLD THEM THAT WE ARE FROM THE CREDENTIALING TEAM OF DR. JODY REED AND GOT SOME BASIC INFORMATION ABOUT THE NURSING HOME FACILITY LIKE NAME: LANDMARK RICHTON PARK, FAX# (708)747-5119 AND EMAIL ADDRESS: ADMISSIONS@LANDMARK-RP.COM. WHEN ASKED ABOUT THE CREDENTIALING INFORMATION THAT THEY NEED FROM US, THE REPRESENTATIVE SAID THAT SHE\'LL NEED TO PULL OUT THE LIST OF INFORMATION THAT THEY NEED SO THEY\'LL EMAIL US AT OUR EMAIL ADDRESS WHICH IS CREDENTIALING.PHYSICIANCARE@GMAIL.COM. WE ARE CURRENTLY WAITING FOR THEIR EMAIL SO THAT WE CAN SEND THEM ALL THE REQUIRED INFORMATION OF OUR PROVIDER.
WE SUBMITTED THE CIGNA BEHAVIORAL PROVIDER INFORMATION FORM ON 19TH JANUARY, 2021 AND ALSO SENT THE CIGNA CONTRACT DOCUMENT SIGNED VIA DOCUSIGN ON AROUND FEBRUARY 16, 2021. WE CALLED TO GET AN UPDATE REGARDING THE FEE SCHEDULE AND PROVIDER ID ETC. THE REPRESENTATIVE CONFIRMED THAT OUR APPLICATION WAS SUBMITTED ON 01/19/21. THE WHOLE PROCESS TAKES 90 TO 100 DAYS AND WE SHOULD GIVE A FEW MORE WEEKS AND THEN CALL AGAIN TO GET THE UPDATE ON OUR CONTRACT.
CALLED CARE MARK (BCBS PHARMACY) REP. SAID THEY REJECTED IT IN AN ERROR, THEN REPROCESSED IT & HAVE PAID THE JACKSON PARK PHARMACY. PLEASE CONTACT THE PHARMACY FOR FURTHER INFORMATION.
JUST CALLED IMPACT ENROLLMENT AND THE REP. ASHLEY SAID THAT PROVIDER IS ACTIVE ON IMPACT IN BOTH INDIVIDUAL & GROUP. THERE SHOULD BE AN ERROR THAT\'S WHY CLAIM WAS REJECTED, I TOLD HER THAT THE PATIENT HAVE A BCBS HMO, SHE SAID THEY ARE THE ONES REJECTING THESE CLAIMS AS THEY DON\'T HAVE UPDATED DATA.
WE TRIED TO GET THE STATUS FOR OUR CREDENTIALING APPLICATION WHICH WAS SUBMITTED ON FEBRUARY 18TH, 2021. ACCORDING TO THE REPRESENTATIVE, THE INITIAL PROCESS TAKES 30 DAYS AND FEBRUARY 18TH IS NOWHERE NEAR 30. SO EVEN IF SHE CHECKS, IT IS NOT GOING TO SHOW UP ANYTHING. IF WE STILL WANT TO GET THE STATUS, WE CAN CONTACT THE SAME EMAIL ADDRESS THAT WE SENT THE DOCUMENTS TO.
ACCORDING TO THE REPRESENTATIVE, OUR APPLICATION WHICH WE SUBMITTED ON 9TH FEBRUARY, 2021 FOR GROUP CREDENTIALING IS CURRENTLY UNDERGOING EVALUATION. IT TAKES 45 DAYS FOR THE EVALUATION PROCESS TO BE COMPLETED AND IT IS THE 23RD DAY. ONCE, IT IS APPROVED, WE WILL BE CONTACTED BY THE WELLCARE TEAM. RIGHT NOW, WHAT WE HAVE TO DO IS TO ALLOW MORE TIME. IT WILL MOST PROBABLY TAKE 23 MORE DAYS AND WE CAN EXPECT A RESPONSE FROM THE WELLCARE TEAM IN THE BEGINNING OF THE MONTH OF APRIL.
OUR NETWORK PARTICIPATION REQUEST FORM (DATED 02/10/2021) IS CURRENTLY BEING PROCESSED. IT WILL TAKE 30 TO 45 DAYS FOR IT TO BE REVIEWED. THE ENTIRE PROCESS WILL TAKE 90 TO 120 DAYS TO BE COMPLETED. ACCORDING TO THE REPRESENTATIVE, THERE ARE NO ERRORS ON THE FORM AND INCASE THERE ARE, SOMEONE FROM THEIR TEAM WILL CONTACT US. AS LONG AS IT IS SUBMITTED, WE ARE GOOD TO GO AND CAN JUST CONTINUE TO CHECK ITS STATUS AT PROVIDER EXPRESS.
WE HAVE SUBMITTED BEACON ONLINE PROVIDER INTAKE FORM FOR INDIVIDUAL. BELOW IS THE LINK TO CHECK THE STATUS OF THE APPLICATION.
HTTPS://JOIN.BEACONHEALTHOPTIONS.COM/VALIDATE/BC812CC7B8FD0E40E053A17D8662435F
SINCE WE DID NOT RECEIVE ANY RESPONSE ON OUR PREVIOUS YOUTHCARE APPLICATION THAT WE SUBMITTED ONLINE, WE HAVE SUBMITTED THE PROVIDER INTAKE FORM AGAIN AND EXPECT TO RECEIVE A REPLY IN 20 BUSINESS DAYS.
NO NEED TO RE-VALIDATE JUST KEEP CAQH AND IMPACT UP TO DATE. THERE IS NO LONGER A MERIDIAN TOTAL, IT HAS BRANDED WITH MERIDIAN COMPLETE, WHICH IS OUR MMAI PRODUCT, IT IS ANOTHER PAYER ID. PLEASE SEE ATTACHMENT.
PLEASE BE ADVISED THAT JODY W REED IS LINKED WITH JODY REED SC UNDER TIN# 27-0123061, PROVIDER ID# IS 212535 FOR JODY REED SC & PROVIDER ID# IS 139293 FOR JODY W REED.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER WAS DIS-ENROLLED IN MAY 2020. HE IS CURRENTLY OUT OF NETWORK. THE BHS PROVIDER ID 1561440 DID NOT PULL UP ANYTHING. FOR THE CREDENTIALING PURPOSE, WE NEED TO GO TO THEIR WEBSITE BEACONHEALTHOPTIONS.COM. THERE WE NEED TO CLICK THE PROVIDER'S TAB AND THEN CHOOSE ''HOW TO BECOME A PROVIDER'' AND THEN SUBMIT THE ONLINE APPLICATION.
WE TRIED TO GET THE STATUS OF OUR APPLICATION (SUBMITTED ON JANUARY 26, 2021) BUT ACCORDING TO THE REPRESENTATIVE IT TAKES UP TO 30 TO 60 DAYS AND SOMEONE FROM THEIR TEAM WILL GET IN TOUCH WITH US AS SOON AS THEY RECEIVE OUR APPLICATION.
WE TRIED TO GET THE STATUS OF OUR APPLICATION WHICH WE HAVE SUBMITTED FOR GROUP CREDENTIALING. THE REPRESENTATIVE TOLD THAT OUR PROVIDER IS STILL NOT PARTICIPATING WITH THE GROUP NPI AND TO GET THE STATUS OF OUR APPLICATION, WE CAN EMAIL AT ABHILCONTRACTING@AETNA.COM.
IT'S BEEN 10 BUSINESS DAYS SINCE OUR GROUP CREDENTIALING APPLICATION SUBMISSION. WE WERE SUPPOSED TO RECEIVE A RESPONSE BY NOW. THE REPRESENTATIVE SAID THAT SHE DOES NOT HAVE DIRECT INFORMATION ABOUT THIS BUT SHE TOOK DETAILED INFORMATION AND SAID THAT SOMEONE FROM THEIR TEAM WILL CONTACT US WITHIN 10 TO 14 CALENDAR DAYS.
WE CALLED TO CHECK THE STATUS OF OUR APPLICATION FOR GROUP CREDENTIALING WHICH WE SENT ON 9TH FEBRUARY 2021. THE REPRESENTATIVE TOLD US THAT OUR PROVIDER IS IN-NETWORK WITH THE INDIVIDUAL NPI (AS TOLD BY THE PREVIOUS REPRESENTATIVE) BUT HE IS STILL NOT IN-NETWORK WITH THE GROUP NPI. IT USUALLY TAKES 10 BUSINESS DAYS FOR A RESPONSE BACK AND IT'S BEEN 9 DAYS SO WE SHOULD CALL AGAIN TOMORROW AND CHECK THE STATUS.
WE NEED APPLICATION STATUS FOR THE PROVIDER INTAKE FORM THAT WE SUBMITTED ONLINE ON 01-26-21 AND THE COVER LETTER AND W9 FORM THAT WE FAXED. THE REPRESENTATIVE WAS UNABLE TO GIVE US THE STATUS BUT PROVIDED AN EMAIL ADDRESS TO CONTACT AND GET THE STATUS. IT IS ILYOUTHCARE@CENTENE.COM.
WE CONTACTED THE TECHNICAL ASSISTANCE DEPARTMENT TO RESOLVE THE ERROR WE ARE FACING ON THE NETWORK PARTICIPATION REQUEST FORM. THE REPRESENTATIVE WAS NOT ABLE TO RESOLVE OUR ISSUE ON HER OWN. SHE TOLD US THAT OUR ISSUE WILL BE FORWARDED TO THE CONCERNED OFFICIALS AND WE SHOULD EXPECT TO GET A CALL BACK OR EMAIL WITHIN 2 TO 10 BUSINESS DAYS.
ACCORDING TO THE REPRESENTATIVE, NO GROUP APPLICATION SHOWS IN THE RECORD. WITH THE INDIVIDUAL NPI, HE STATED THAT PROVIDER IS OUT OF NETWORK AND THE APPLICATION WE TRIED TO SUBMIT YESTERDAY IS INCOMPLETE. WE HAVE TO MAKE SURE THAT W9 AND THE TAX ID NUMBER ARE MATCHING.
ACCORDING TO THE REPRESENTATIVE, THE PROVIDER IS OUT OF NETWORK. THERE IS NO GROUP CONTRACT. FOR CREDENTIALING, WE HAVE TO SEND OUT AN APPLICATION AT PROVIDEREXPRESS.COM AND SUBMIT IT ONLINE. THE RESPONSE BACK WILL TAKE 30-45 DAYS AND THE CREDENTIALING PROCESS WILL TAKE 90-100 DAYS AND A MAXIMUM OF 6 MONTHS.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER IS IN-NETWORK WITH AETNA WITH THE INDIVIDUAL AS WELL AS THE GROUP NPI. THE PROVIDER ID IS 7109742. THE EFFECTIVE DATE IS 08-17-2018.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER IS IN-NETWORK WITH THE INDIVIDUAL NPI FOR MEDICAID BUT NOT FOR MEDICARE AND NOT IN-NETWORK WITH THE GROUP NPI. FOR THE ENROLLMENT, WE NEED TO GO TO THEIR WEBSITE I.E. MERIDIANTOTAL.COM AND CLICK ON ''JOIN OUR NETWORK''. FROM THERE, WE HAVE TO FILL THE PROVIDER INTAKE FORM AND SUBMIT IT ONLINE.
ACCORDING TO THE REPRESENTATIVE, THE PROVIDER IS NOT IN-NETWORK WITH THE INDIVIDUAL OR THE GROUP NPI. ON ASKING ABOUT THE ENROLLMENT PROCESS, SHE INSTRUCTED TO FILL THE PRIOR AUTHORIZATION FORM AT CORP.NHPLAN.COM AND FAX TO (844)409-5557. (THE INSTRUCTIONS SEEM INCORRECT AND WE WILL CALL AGAIN)
THE PROVIDER IS IN-NETWORK WITH WELLCARE WITH THE INDIVIDUAL NPI. HIS WELLCARE ID IS 1504849. THE CREDENTIALING DATE FOR IMR IS 12-21-2017 AND FOR OTHER LINES OF BUSINESS IS 05-15-2020. NO RE-CREDENTIALING DATE WAS PROVIDED. HOWEVER, THE DOCTOR IS NOT IN-NETWORK WITH THE GROUP NPI. FOR HIS ENROLLMENT PROCESS, WE NEED TO GO THEIR WEBSITE WHICH IS WELLCARE.COM AND TELL WHERE THE GROUP NPI IS LOCATED (ILLINOIS). ON THE PROVIDER'S TAB, WE HAVE TO CLICK WELLCARE PROVIDER AND THEN CLICK ON THE HIGHLIGHTED LINE WHICH SAYS ''JOIN THE WELLCARE NETWORK''. AFTER THAT WE HAVE TO FILL THE FORM AND SUBMIT IT ONLINE.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER IS NOT IN-NETWORK WITH THE INDIVIDUAL OR WITH THE GROUP NPI. (WE WILL CALL AGAIN TO CONFIRM THE INFORMATION)
WE CALLED THE HUMANA INSURANCE FOR THE CONFIRMATION OF CREDENTIALING AND RECREDENTIALING DATES OF OUR PROVIDER. THE REPRESENTATIVE PROVIDED US THE APPROVAL DATE AND RECREDENTIALING DATE FOR THE INDIVIDUAL PROVIDER WHICH ARE 02-04-2019 AND 02-04-2022 RESPECTIVELY. HOWEVER, SHE COULD NOT PULL UP THE DATA FOR GROUP NPI. REPRESENTATIVE HAS TAKEN THE CALLBACK NUMBER AND WILL GIVE US CONFIRMATION ABOUT THE GROUP CREDENTIALING DATES BY CALLING BACK SOON.
AS INSTRUCTED BY THE REPRESENTATIVE, WE HAVE FILLED THE NON-PAR PROVIDER CONTRACT REQUEST FORM FOR GROUP ENROLLMENT OF OUR PROVIDER AND SUBMITTED IT TO THE GIVEN EMAIL ADDRESS WHICH IS MHILPROVIDERNETWORKMANAGAMENT@MOLINAHEALTHCARE.COM
THE REPRESENTATIVE PROVIDED US THE CREDENTIALING/EFFECTIVE DATES WHICH ARE 07/01/2017, 10/01/2014 AND 01/01/2006. THE DUE DATE FOR RE-CREDENTIALING IS 02/04/2022. THE REPRESENTATIVE ALSO PROVIDED THE HUMANA BEHAVIORAL HEALTH NUMBER FOR FURTHER ASSISTANCE WHICH IS (844)291-2162.
WE NEEDED GUIDANCE REGARDING THE FORM WHICH WE HAVE TO SUBMIT FOR GROUP ENROLLMENT OF OUR PROVIDER. THE REPRESENTATIVE WAS ABLE TO GIVE US DETAILED INSTRUCTIONS. WE HAVE TO GO TO THE HOMEPAGE ON THEIR WEBSITE I.E. MOLINAHEALTHCARE.COM AND SELECT THE STATE OF ILLINOIS. ON THE MIDDLE OF THE PAGE IS A TRIANGLE WITH HOW CAN I HELP YOU? WE HAVE TO CHOOSE HEALTHCARE PROFESSIONAL THEN MEDICAID PROFESSIONALS. AFTER CLICKING THE NEXT PAGE WILL APPEAR WITH GREEN TABS WHICH WILL HAVE FORMS. FROM THE FREQUENTLY USED FORMS, WE HAVE TO SELECT THE FIFTH ONE WHICH IS CONTRACTING AND PROVIDERS FORM. A LIST OF FORMS WILL APPEAR WITH GREEN HYPERLINKS. THERE WE HAVE TO CLICK THE ''NON PAR PROVIDER CONTRACT REQUEST FORM.'' IT WILL ALSO HAVE THE EMAIL ADDRESS MENTIONED ON WHICH WE HAVE TO EMAIL IT.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER IS PARTICIPATING WITH BOTH NPIS AND THERE IS NO NEED FOR A FURTHER PROCESS. HOWEVER, THE REPRESENTATIVE WAS UNABLE TO GIVE US THE PROVIDER ID.
THE PROVIDER IS NOT IN-NETWORK WITH THE GROUP NPI. THE REPRESENTATIVE HAD NO ACCESS TO THE UPDATES REGARDING PROVIDER INTAKE FORM WHICH WE SUBMITTED ONLINE. HOWEVER, SHE WAS ABLE TO CHECK THE RECORD FOR THE FAXES SENT IN JANUARY AND OUR W9 FORM WAS NOT THERE. SHE TOLD THAT ALL WE NEED TO DO RIGHT NOW IS TO SEND THE W9 FORM AT THEIR FAX NUMBER WHICH IS 8449311229 AND SOMEONE FROM THEIR TEAM WILL CONTACT US.
THE PROVIDER IS NOT IN-NETWORK WITH THE GROUP NPI. ACCORDING TO THE INSTRUCTIONS GIVEN BY THE REPRESENTATIVE, WE HAVE TO GO TO THEIR WEBSITE I.E. MOLINAHEALTHCARE.COM AND FILL THE PROVIDER CONTRACT REQUEST FORM. WE HAVE TO SUBMIT IT BY EMAIL OR FAX. THE EMAIL ADDRESS IS MHMSPROVIDERCONTRACTING@MOLINAHEALTHCARE.COM. THE FAX NUMBER IS 8443035188.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER IS STILL NOT IN-NETWORK WITH THE GROUP NPI. WHEN ASKED ABOUT THE ONLINE FORM WHICH WAS SUBMITTED BY US ON AETNA'S WEBSITE, THE REPRESENTATIVE TOLD THAT SHE DOES NOT HAVE ACCESS TO THAT INFORMATION AND WE'LL HAVE TO EMAIL THEM FOR THE UPDATE.
SPOKE TO REP. BUT CLAIM WAS NOT ON FILE, CLAIM WAS BILLED TO ILLINOIS MEDICAID AS PRIMARY, CHECKED ELIGIBILITY AND FOUND PATIENT HAS MEDICARE AS THE PRIMARY INSURANCE & MEDICAID AS SECONDARY, PATIENT IS QMB PROGRAM ENROLLED. WE NEED TO CORRECT THE CLAIM & SEND IT TO THE CORRECT PAYER.
THE CIGNA BEHAVIORAL PROVIDER INFORMATION FORM WAS SUBMITTED BY US ON 19TH JANUARY, 2021. ACCORDING TO THE CIGNA REPRESENTATIVE, AT THIS POINT, THEY ARE STILL PROCESSING OUR APPLICATION AND IT HAS NOT BEEN REJECTED OR DENIED.
YOUTHCARE REPRESENTATIVE CONTACTED OUR PROVIDER AND INSTRUCTED TO FILL THE PROVIDER INTAKE FORM AVAILABLE AT ILYOUTHCARE.COM. WE HAVE FILLED AND SUBMITTED THE FORM. THE REVIEW AND RESPONSE FROM YOUTHCARE WILL TAKE 20 BUSINESS DAYS. IF THE CONTRACTING PROCESS MOVES FORWARD, IT WILL TAKE AN ADDITIONAL 60-90 DAYS TO COMPLETE.
WE NEEDED A FEW GUIDELINES REGARDING THE EFT ENROLLMENT FORM OF OUR PROVIDER INCLUDING SUPPLIER NO AND CONFIRMATION OF MAILING ADDRESS. THE REPRESENTATIVE, AFTER TALKING TO THE SUPERVISOR TOLD US THAT THEY WERE UNABLE TO ANSWER OUR QUERIES REGARDING THE FORM. ALSO NO CONFIRMATION OF MAILING ADDRESS WAS PROVIDED.
WE FILLED AND SUBMITTED THE AETNA BETTER HEALTH FORM FOR GROUP NPI ENROLLMENT OF OUR PROVIDER ON 01/18/2021. NO EMAIL HAS BEEN RECEIVED FROM THEIR TEAM YET. ON INQUIRY, WE HAVE BEEN TOLD BY THE REPRESENTATIVE THAT A RESPONSE BACK CAN TAKE 30-45 DAYS AND HENCE WE HAVE TO WAIT.
OUR PROVIDER IS GETTING PAPER CHEQUES AND HENCE NEEDS TO BE ENROLLED FOR EFT. ACCORDING TO THE INSTRUCTIONS GIVEN BY THE REPRESENTATIVE FOR EFT ENROLLMENT, WE HAVE TO GO TO THEIR WEBSITE I.E MOLINAHEALTHCARE.COM, CHOOSE ILLINOI AT THE TOP STATE AND CLICK THE HEALTHCARE PROFESSIONALS MEDICAID OPTION. FROM THE FREQUENTLY USED FORMS, WE WILL GET THE CONTRACTING PROVIDERS FORM. THERE WE HAVE TO CHOOSE THE PROVIDER PROFILE AT EFT REGISTRATION FORM, FILL THAT OUT AND SEND IT.
AS INSTRUCTED BY THE CALL REPRESENTATIVE FROM CIGNA, WE HAVE FILLED THE CIGNA BEHAVIORAL PROVIDER INFORMATION FORM AND SUBMITTED IT ONLINE. THE FORM INCLUDES THE APPLICANT INFORMATION, PROFESSIONAL CONTACT INFORMATION, MAILING ADDRESS, HOSPITAL AFFILIATIONS, TAXPAYER INFORMATION, PRIMARY SERVICE LOCATION, PRACTICE INFORMATION, SPECIALTY NETWORKS AND MORE. ACCORDING TO THE REPRESENTATIVE, AN EMAIL WILL BE RECEIVED WITHIN THE NEXT 24 HOURS WHILE THE CREDENTIALING PROCESS MIGHT TAKE UP TO 120 DAYS.
WE NEED TO CREDENTIAL OUR PROVIDER WITH THE GROUP NPI. ACCORDING TO THE INSTRUCTIONS GIVEN BY THE REPRESENTATIVE, WE NEED TO GO THE WEBSITE AND FILL OUT THE FORM THERE. THE FORM WILL BE SUBMITTED ONLINE AND A MAILING ADDRESS WAS NOT PROVIDED.
ACCORDING TO THE REPRESENTATIVE, OUR PROVIDER IS IN-NETWORK WITH THE INDIVIDUAL NPI. HOWEVER, HE IS NOT IN-NETWORK WITH THE GROUP NPI AND GROUP NPI ENROLLMENT CAN BE DONE AT THE PORTAL ON AETNA'S WEBSITE.
AS PER THE REP. SHE COULD NOT FIND THE PROVIDER AS IN-NETWORK WITH TAX ID 270-123-061, ALTHOUGH THE PROVIDER IS IN-NETWORK WITH OTHER TAX IDS (I.E BETHANY HOMES 362-012-788 & FRIEDELL CLINIC SC 363-290-656).
OUR PROVIDER REED,JODY MD ONLY NEEDS TO UPDATE THE INFORMATION. A COPY OF W9 FORM ALONG WITH THE COVER LETTER TO BE FAXED ON (844)931-1229 ATTN: PROVIDER DATA MANAGEMENT WITH SUBJECT "NETWORK NEEDS TO BE UPDATED".
BRIEF COVER LETTER INCLUDES PROVIDERS NAME, INDIVIDUAL NPI, PRACTICE NAME & GROUP NPI, TAX ID, TAXONOMY NUMBER AND LINE OF BUSINESS THAT WILL BE "YOUTHCARE HEALTHCHOICE".
CLAIMS ARE BEING CONTINUOUSLY REJECTED ON CHANGEHEALTHCARE (EMDEON) PORTAL DUE TO "INVALID MEMBER". AS PER REPRESENTATIVE ALL THE CLAIMS SUBMITTED IN DECEMBER 2020 AFTER 12/19/2020 WERE ALL REJECTED DUE TO THEIR SYSTEM ERROR, NO NEED TO RESUBMIT THE CLAIM AS THEY WILL REPROCESS IT IN 3 WEEKS TIME. ALL THE PATIENT, CLAIM, PROVIDER DETAILS & PAYER ID WERE CORRECT. NEED TO FOLLOW UP ON ALL THESE REJECTED CLAIMS.
WE COULD NOT HELP IN CODING , CONSULT CODING REFERENCE GUIDE IN THIS MATTER, TIME LIMIT IS MAX. FOR ANY CPT, AND NO ADDITIONAL DOCUMENTATION IS REQUIRED.
PROVIDER IS PARTICIPATING (IN NETWORK) WITH INDIVIDUAL NPI DATED 12/01/2020 BUT NON PARTICIPATING (OUT OF NETWORK) UNDER GROUP NPI, WE NEED TO HAVE PRIOR AUTH BEFORE RENDERING SERVICES WHEN BILLING UNDER GROUP NPI.