It is a New Normal

Commercial payers have been forced to accept telehealth services as an effective method of healthcare. Prior to the public health crisis, it was often difficult to obtain a participating provider contract from payer networks for telehealth services. Sure, there are many large telehealth companies such as Teladoc or Physicians Now who contract with every payer in the country. But obtaining a participating provider contract for a solo or a small group was extremely difficult, and many payers would openly refuse. Times have changed and the telehealth method of service delivery for physicians is much more common. Many payers still will not issue contracts to solo or small groups, but many are open and accepting of telehealth only medical practices or a hybrid approach of in-person and telehealth visits.

insurance credentialing

The Credentialing Process

When you approach a payer network to participate as a telehealth provider, there are a few key things to remember. First, be certain to identify your practice as being telehealth only if that is indeed your model. Make sure you disclose that you do not have a clinic where patients come for treatment. Do not assume you can simply credential with your home address and think that provision of telehealth services is understood, it is not that simple.

Next, you will need to disclose where you are providing services from. Your originating address should be noted as a “telehealth location only” so that it is not reported in provider directories as a clinic office. Your service address should not be a PO box or a virtual office address (such as provided by UPS store or similar service).

Next, be prepared to disclose what platform you utilize to provide services such as SimplePractice, or, or any of the many other HIPAA compliant telehealth platforms. Most EHRs now have a telehealth services component to their platform.

And finally, be prepared to get declined. As mentioned previously not every payer is offering participating contracts to telehealth only practices.

Improve Your Chance For Success

Improve your chances of payer acceptance by having a clinic address for in-person services. The hybrid model of having a clinic location where patients are treated as well as providing telehealth services will be a more traditional request. Such a request to participate may have a better chance of getting an in-network provider contract from commercial payers. It is very important that you not attempt to report a home address or a virtual office address as a place where patients are treated. These types of addresses will likely create quick denials and in the case of Medicare may trigger a site visit to the location and could possibly cause an application denial and problems with future enrollments in the program.

There are many resources available to assist with planning for your telehealth practice. Start with the American Telemedicine Association and you will find many resources for planning remote care services. The Department of Health and Human Services also provides some information about telemedicine that can be helpful. Your primary professional association is likely to have tools available to assist with incorporating telemedicine into your practice or starting a telehealth only type of service.