Saturday, February 25, 2012

Credentialing Changes


There may come a time when your practice changes tax id number or demographics (address, phone, etc.). If a change of this sort happens it is imperative that all insurance carriers are updated. If the insurance has the wrong mailing address, you will not receive payments or correspondence. If the insurance pays claims under the wrong tax id it could be an accounting nightmare. 


Insurance requirements for these changes vary. Minor demographic changes usually require a short form or just a letter on practice letterhead. All demographic changes must be accompanied by a signed W9 which is an IRS form that indicates the practice demographics and tax id number. You must call the insurance and ask what their procedure is for a provider demographic change. All of the same tracking and follow up guidelines mentioned in previous posts apply. 


Your request must be very clear with no room for misinterpretation. Also, it is very important to understand that some provider information changes can result in changes to your participation status. For example some insurances credential within a certain location or region and even a move across the street can move you out of their region. Be sure to ask if there is any potential for problems and most importantly FOLLOW UP regularly. Remember provider demographic problems will result in denied claims.


As stated before, some insurance requires only a letter. To follow is an example of a letter for provider demographic change and a link to the IRS's W9 form. Thought this may be helpful to understand what I mean.


IRS form W9 (2011)
Form Letter Sample for Provider Demographic Change 

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