Article

How do I get my In Network Participation status?

Provided by:  Jennifer Kirschenbaum, Esq.

April 9, 2019

 

Question


Hi Jennifer,

I plan to leave my job soon and I am now concerned I do not know which insurance plans I participate with.  Thoughts?

Thank you,
Dr. P

Answer

Absolutely request from your current employer not only your status, but also copies of any credentialing applications and contracts signed by you, or on your behalf.  You can certainly give notice first and then request.  It would be pretty unethical for an employer to refuse to provide you with a proper answer to the aforementioned request - one reportable, and potentially actionable,  by OPMC.

A concern related to participating status is the nature of participation - do you participate by way of an individual contract putting you in direct nexus with a third party payor, or are you participating through the employer's tax ID?  If the latter, a new position may be a clean slate.  If the former, your status may follow. 

Another option, less palateable, is to inquire with the payers by website or phone... 
 

Looking for the KK Healthcare Exchange?  Click Here. 

MISSED OUR RECENT WEBINARS?  CLICK HERE ANYTIME!
Looking for HIPAA and compliance forms?  
Click here to visit our website.
Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.
Interested in having Jennifer speak at an event or
at a residency/fellowship program?
Contact Jennifer directly at (516) 747-6700 x. 302 or at Jennifer@Kirschenbaumesq.com
Click here to learn about
K&K's Prepaid Legal Audit/Investigation Defense Now!
How do I get my In Network Participation status? - April 9, 2019 - Jennifer Kirschenbaum

Article

How do I get my In Network Participation status?

Provided by:  Jennifer Kirschenbaum, Esq.

April 9, 2019

 

Question


Hi Jennifer,

I plan to leave my job soon and I am now concerned I do not know which insurance plans I participate with.  Thoughts?

Thank you,
Dr. P

Answer

Absolutely request from your current employer not only your status, but also copies of any credentialing applications and contracts signed by you, or on your behalf.  You can certainly give notice first and then request.  It would be pretty unethical for an employer to refuse to provide you with a proper answer to the aforementioned request - one reportable, and potentially actionable,  by OPMC.

A concern related to participating status is the nature of participation - do you participate by way of an individual contract putting you in direct nexus with a third party payor, or are you participating through the employer's tax ID?  If the latter, a new position may be a clean slate.  If the former, your status may follow. 

Another option, less palateable, is to inquire with the payers by website or phone... 
 

Looking for the KK Healthcare Exchange?  Click Here. 

MISSED OUR RECENT WEBINARS?  CLICK HERE ANYTIME!
Looking for HIPAA and compliance forms?  
Click here to visit our website.
Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.
Interested in having Jennifer speak at an event or
at a residency/fellowship program?
Contact Jennifer directly at (516) 747-6700 x. 302 or at Jennifer@Kirschenbaumesq.com
Click here to learn about
K&K's Prepaid Legal Audit/Investigation Defense Now!