Can I see an HMO's patients before my credentialing is approved?

July 18, 2008

I applied to get credentialed with another managed-care company but haven't yet received final approval. May I start seeing their enrollees anyway?

I recently applied to get credentialed with another managed-care company but haven't yet received final approval. May I start seeing their enrollees anyway?

It depends on the insurer. Some plans won't pay for any services you render before you're fully credentialed with them. Other plans have more lenient policies and may allow a specific window of time to submit such claims once credentialing is complete. Check your contract or ask the contract representative. If the contract doesn't address the issue but the representative says that you can bill before being fully credentialed, ask for written confirmation. Also make sure that in-network benefits will apply.

Send your practice management questions to:PMQAEditor, Medical Economics, 123 Tice Blvd., Suite 300,Woodcliff Lake, NJ07677-7664, or send an e-mail to mepractice@advanstar.com (please include your regular postal address).