Insurance Credentialing After You Relocate

We routinely hear from healthcare providers who have relocated to another state or are planning a relocation, and need assistance with getting in-network with insurance panels in their new practice state.  Many are frustrated or uncertain when they learn that they must start the credentialing and contracting process all over with their new practice location even though they participated with the same insurance networks in another state.  Let’s look at some of the key points to consider when relocating.

Medicare Provider Enrollment

Each state has a contractor that is responsible for administering the Medicare program.  These contractors are called Medicare Administrative Contractor’s (MAC’s).  Each MAC handles the enrollment and claims processing for all activities within its state jurisdiction.  Every provider who participates with Medicare must have an enrollment record on file with the MAC in the state(s) in which s/he practices in order to receive Medicare reimbursement for claims.  When a provider moves to another state or opens a new location in another state, then the provider must submit an enrollment package to the MAC that administers the new state.  Your Medicare enrollment record in one state does not transfer to another state; you must start from the beginning to enroll with the MAC who administers the program in your new state.  You will need to enroll your business entity (PC, LLC, Inc, etc) with the MAC along with yourself personally to obtain new Medicare Provider Transaction Numbers (PTAN).  Allow 60 – 90 days for Medicare to complete your enrollment application.

BCBS Credentialing and Contracting

Each state has a Blue Cross Blue Shield association and your contract does not travel with you if you relocate.  With some exceptions in state border areas, you will need to undergo credentialing with your new state BCBS association and obtain a participating provider agreement in the new state.  Your previous credentialing file in another location provides no benefit when credentialing for your new location.  Allow 90 – 120 days for completion of credentialing and contracting

Commercial Insurance Credentialing

The majority of insurance networks will require new credentialing and contracting when you relocate.  There are a few national PPO networks that may only require a new contract be issued, but most companies will require you to be credentialed as a new applicant in your new state of practice.  Most insurance credentialing and contracting is completed in the 120 day range, with some quicker and some slower.

Medicaid Provider Enrollment

Each state has its own Medicaid program and you must enroll in each state separately.  Like Medicare, most Medicaid enrollments require you to enroll your business entity and your individual providers.  Medicaid programs are notoriously slow for processing applications.  Some states take six months or more just to credential and contract a single provider.  Many are moving to an electronic application process that will help improve turnaround, but most are still stuck with a paper based system and poor controls in place to process applications.

Summary

If you are planning to move your practice to a new state, be sure to allow plenty of time to complete credentialing and contracting for the payers that are important to your practice.  Be aware that you will have to start the process over from the beginning for each insurance company that you participate with.

About nCred

nCred is a leader in provider enrollment services and serves all states and can assist practitioners with the credentialing process for any insurance networks.  Call nCred today at (423) 443-4525 to discuss your needs, or fill out our online request form here and a representative will contact you.