If you are a group practice that is considering or will take at least one insurance company, this section is for you.
What do I need to change? Is there a group application or do my clinicians apply individually? What is an NPI-2 and do I need it? Do the clinicians use their NPI and my Tax ID and do the checks get made out to my group or them?
Here are the steps you can take to panel your clinicians in your group practice:
- If you are already paneled with insurance companies start by writing a list of each company you are in network with individually and their provider relations contact number or email. If you aren’t already in network with insurance, write down the insurance(s) you would like to panel with as a group.
- Go to the NPI website and apply for an NPI-2. This is separate from your individual NPI and the individual NPIs your clinicians will need. This is just for your business. Some insurances will need this, some may not, but it is best to have it.
- Contact each insurance company (before you hire anyone, but if you already have then no need to worry) and ask if they have group practice applications. Some will and some won’t. For example, in Illinois, where we are based, United Healthcare can be in as a group if you have 5 or more clinicians and BCBS can be a group if there are 2 or more clinicians.
- For those insurances that do not have group status, each of your new clinicians will apply individually, using YOUR TAX ID NUMBER, and YOUR GROUP NPI-2, along with YOUR BUSINESS ADDRESS and THEIR NPI-1 number. That way checks come to your office and under your business name. When they apply, they will fill out a W-9 for each insurance and list your business name and TIN on it.
- For those insurances that DO have group status, apply for group status and ask to add your info to it (if you are already in network individually). Again, new clinicians will use YOUR NPI-2, YOUR TAX ID and THEIR NPI-1 on applications so that checks and EOBs come to your business.
- Have your clinicians put your Tax ID and not the social security on the W-9 forms or anywhere else. This is how your business gets the checks and not the clinicians individually. Plus, they are conducting sessions at your business so your Tax ID should be linked to the claims. (Side note-they will complete a W-9 with their information for your records for when tax season comes, but this does not go to insurances).
- Make sure that they are listing your group practice as the service address and claims address.
- Make sure clinicians update their CAQH to reflect them working at your business, if they haven’t already. Insurances will check this and it will delay progress if it is not updated.
- The benefit to being listed as a group practice with insurances that allow it rather than having everyone paneled individually is that 1) you can usually panel new clinicians quicker and 2) you have more leverage to ask for rate increases.
It really is not difficult to panel clinicians to your group practice. You can do it! There is a great Facebook Group called Insurance Billing and Credentialing for Mental Health Clinicians that is a great resource!
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