Insurance Committee Report

Is board certification required in the credentialing process by insurance companies to be a provider?

For some reason this has been a hot topic amongst residents. I could not find any insurance companies i.e.; Blue Cross/Blue Shield, Cigna, United, Medicare etc. in the Midwest Region that require or will require Board Certification in order to retrieve your provider numbers.  There have been incidents in Michigan which some Blue Cross Products sent out information regarding this requirement, but it was rescinded. However, if you are seeking to be on a Network HMO panel or managed care panel which is usually done through your hospital affiliations – the hospital i.e.; (Advocate System) might require Board Certification to be affiliated with that hospital. Board Eligibility is usually required to get the hospital privileges and the hospital will allow you a window, usually 5-7 years, to become certified.

If you have any documentation where you have been denied credentialing by an insurance company because of board certification, please contact the IPMA office.

Is there any further news on the – 25 modifier situation?

Please know that this an ongoing issue in all specialties of physician/ancillary reimbursement. The IPMA along with other state podiatry associations have written letters to BC/BS clearly emphasizing the need for modifier with explicit examples. It is a process and it will require some time to rectify. It does not affect all of the Blue Cross Plans. There is also a collaborative effort with APMA and other professional medical organizations to resolve this issue.

Is there a transition period for the new Medicare Numbers?

Yes, beginning April of 2018, Medicare enrollees have been receiving new cards with new numbers. Please note that BOTH numbers work during the one-year transition period which will end in April of 2019. Make sure you ask your patients if they received a new card so that you record the new number.

Jondelle B. Jenkins

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