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@@Rajneshpandit I have actually heard that from multiple people since the beginning of the year. It sounds as if the execution of this change over was not well planned or implemented. I know some clearinghouses are also not able to submit claims either because claim enrollment is required, however, there are some challenges between the payer and the clearinghouse at this time to do so. I am sorry you are experiencing this. Hopefully it gets better in the coming weeks.

@@BurningUp99 thank you for the feedback and for watching! I’m glad you learned something new.

Hi and thank you for watching. If you now need to bill TriWest then you would need to enroll with the payer to bill for services accordingly, if you’re not already.

@@AkramAli-sl6iq hi there. These are plans where patients have Medicare as primary and Medicaid as secondary. For DSNP, the primary insurance is with a Medicare Advantage plan through a commercial payer, so the claim needs to be submitted accordingly per their eligibility check. Here is a helpful link about UHc’s DSNP and explains how these plans work in general. www.uhc.com/communityplan/dual-special-needs-plans/what-is-a-dsnp?cid=ps:dsnp-ggl-nb-p-dual-pm-8030209:088cf8f6&WT.mc_id=8030209&gad_source=1&gclid=CjwKCAiA7Y28BhAnEiwAAdOJUNgctWVR7d8LROxusLNEqjhqqj99ZTmgqA75MTPByLBi3VoegYunnRoCvWQQAvD_BwE&gclsrc=aw.ds QMBs go directly to Medicare A or B and then Medicaid pays as secondary. Here is a good link from CMS www.cms.gov/medicare/medicaid-coordination/about/qualified-medicare-beneficiary-program These patients, for either program, should never receive a bill. I hope this helps and thanks for watching!

@NavigtingtheBusinessofMedicine Hope so you are good, Thank you so much for promptly anticipation. Really appreciated. I am always watching your videos. Stay blessed 🙏

@@KP-ev1ti hi there! Absolutely! Jennifer@icsolns.net. I will do my best to answer. Thank you for watching!

Informative, thanks

Hi there and thank you for watching. Multiple insurances can be very confusing and sometimes the way they process depends on the type of insurance each of them are (i.e. commercial, Medicare or Medicaid plans). If both of yours are commercial plans, then you have to meet your primary insurance deductible before the secondary will generally start to pay anything. The purpose of the secondary insurance is to cover anything that goes to patient responsibility after the insurance pays their portion. Insurances will not pay for anything until you hit your deductible. Patients in your situation may feel having 2 insurances that both have high deductibles may not be financially worth it. I would recommend calling your secondary insurance plan, let them know your benefits of your primary plan and ask them when/how they will start to pay. That will help you know specifically for your plans.

@@Smiseter6937 you would need to move forward with out of network enrollment, however, it sounds like they pay the same rate. You would just need to make sure that you follow their out of network protocols when it comes to requirements for authorizations and referrals. They have been closed for quite a while, and I don’t think they give an ETA of when they may open it up again thank you for watching!

@@jevettamd thank you for watching. In my experience, Tricare West and East always reimburse using the Medicare fee schedule and fees will fluctuate based on the state the doctor resides just like Medicare rates do. However, I have not been able to find anything stating if or how the fees will change with this new contract. I encourage practices to contact the payer directly with these questions. Enjoy your day.

@@NickyeNvann hi there and thank you for watching. Which videos are you referring? I have many credentialing and contracting videos on my TH-cam channel and have playlists too. If you are looking for my credentialing course, those are subscription based and hosted on the Thinkific platform. The QR code in the opening of all my new videos will take you directly to the site or you can click here navigatingthebusinessofmedicine.thinkific.com/courses/healthcare-credentialing-and-contracting. Thank you for supporting my channel!

@@ih8brusselssprouts yes it’s so difficult for both the practice staff and patients. California and Pennsylvania/tri-state area has all those confusing scenarios as well. Thanks for watching!

It is something that seems to be a little difficult for people to understand. Thank you for watching!

Hi there and thank you for asking! Wellness visits are best to be billed under the NPP performing the services. Remember incident-to is for professional services only so any in-house labs and tests (i.e ECG) that could be done during the visit would not qualify for incident-to billing. Incident-to is applicable anytime there is a care plan set forth by a doctor so even for acute needs that may need a follow up, not just chronic conditions (although that is when it would be most applicable). Making changes to medications, or adding a medication for an existing care plan/diagnosis would qualify as long as that is part of the intended reason for the follow up. I hope this helps- good luck and thank you again!

@@JohnPiontkowski thank you for watching. Unfortunately, I don’t know DME that well to answer that. There are different categories of DME and there are already existing CPT codes for most DME that is covered. I would recommend checking the CMS guidelines on the website to see if they mention anything. I appreciate you supporting my channel.

I’m sorry to hear that and it is super frustrating for patients when they make things so complicated. My guess is that your insurance is now through a Managed Care Organization (MCO) with Anthem. I would call your local Anthem plan by looking for the Customer Service number on the internet. I’m sure if you are registered with them, they will be able to assist. Also, if any of the doctors’ offices have access to the Medicare or Medicaid portal then they should be able to provide you with your Anthem subscriber ID and information too. It should not prevent you from being seen either if they take that insurance. Good luck and thank you for watching. And just so you know, this year I am going to be starting videos specifically directed to patients on topics exactly like this. I will be releasing one video every other week so please keep your eye out for those.

Providers are the ones licensed in each state so you would need to check with each state’s individual licensing board (i.e medical board for doctors and PA’s, nursing board for NP’s, etc.) to see if they offer this or not. If not, then it would just be a standard practicing license. I hope this helps and thank you for watching! Happy New Year!

In healthcare you will always find this difference and it depends on what type of job you want, whether you want to work for a large corporation or an independent practice. Private practices, especially those on the smaller to medium size would probably not be able to pay that salary even for a Certified Credentialing Specialist. Although Certification will be important, many employers will also state something to the likes of “or experience equivalent” as actually having done the job is invaluable. Thank you for sharing!

How do I get certified help!!!!

Hi there and thank you for watching. My course does not provide any certifications or have any tests. They are self-paced and can be replayed as often as you’d like. I don’t remember exactly how long each is, but I believe each level is about 2-2.5 hours long if you watch it without stopping. Thank you for your support.

@@maryoledibe4618 hi there and thank you for watching. Everything for Medicare is done via the PECOS portal. I have videos about this so please be sure to watch those. Once you enroll through Medicare for your new practice, you will be assigned a different Medicare number for the group, as well as for you as an individual working at that specific group. You may need to call your local Medicaid to find out what your number is, however, many state Medicaid plans do the same thing as Medicare and require you to enroll the new group and affiliate yourself as the provider with the group and they will assign new Medicaid numbers that are specific to that practice as well. Good luck!

@@MrKentaylor31089 hi there! You will need to enroll your new clinic with Medicare via PECOS and also update your individual information as well by reassigning to that new group. If you’re the owner, it will allow you to do it all at once most of the time. Thank you for watching and Merry Christmas!

Merry Christmas! Yes, if you are par with your local BCBS then out of state BCBS plans will process as in-network. Thank you for supporting my channel and for the kind words!

@@NavigtingtheBusinessofMedicine I would just add that this is true for PPO plans, but not necessarily for HMO or EPO plans.

Thanks for watching!

Yes, I believe you do, but I have never personally had to figure out that situation so please go to the DEA website to confirm. Merry Christmas and thank you for watching!

All states have different situations when it comes to IPAs. I recommend going into Google and searching for IPAs in the area in which you are interested. Then go to each of their individual websites, if you have any, and learn specifically about each one that way. Thank you for watching!

Hi there! Thanks for continuing to watch my videos and comment! Happy Holidays!!

You’re so sweet! I appreciate your support and kind words! I’m happy to help any career-specific questions you have. Please email me jennifer@icsolns.net. Enjoy your day!

@@NavigtingtheBusinessofMedicine Thank you!! I will!

@@modasalvador7435 Thank you! I truly appreciate you supporting my channel.

Thank you for watching! Honestly, I don’t have any favorite billing companies because every company has their own niche and every healthcare practice has their own needs. I know that seems like a very generic answer, but it is very true. Enjoy your day!

Thank you so much! I’m glad you have found it informational! I appreciate the support.

@@rinaaguilar9518 you are so welcome. Feel free to email me at iennifer@icsolns.net. Have a good day!

Thanks for watching

Thank you and I’m happy to hear you have found my videos valuable. That’s exciting for you - good luck!!

Thanks for watching!

Thank you for watching and I’m glad you have found it helpful. Unfortunately, I do not make videos on specific state Medicaid plans because the Credentialing and contracting basics are the same for all. You just need to research on their site for specific requirements and steps for that state. Here is the link and good luck portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_Enrollment/Provider_Enrollment_EnrollmentApplication/tabId/67/Default.aspx?desktopdefault=

Thank you very much ❤

I appreciate your kind words and support of my channel!

IPAs leverage the power in numbers by taking multiple independent practices and providers and combining them into one for negotiating with insurance companies. In many places, if you are not part of an IPA, then you may not bill or be paid by some payers. California is one state that is heavy in IPAs. Other states they are practically unheard of, so it’s important to know the payers in all areas. Good luck and thank you for watching!

@@gippygrewal8449 100% agree! Such a sad reality. Thank you for watching my channel and Happy Thanksgiving!!

You can email me at jennifer@icsolns.net and I can see how I can help you. Thank you for watching.

Hi there, I apologize I am not aware of any. I would recommend looking online at job web posting sites such as Indeed. Thank you for watching!

Usually your billing system will attach the primary payer’s ERA with the claim to the secondary payer. You would have to learn how the specific system you’re using will do that. Most insurances will receive an electronic claim so you would not have to send a HCFA 1500 form anyway. In terms of Medicare as primary, if they are aware there is a secondary insurance, such as Medicaid, then they would automatically forward the claim for you to the secondary payer and you would not have to worry about that. I hope this helps. Thank you for watching!

I’m so happy to hear this will help you! Thank you for watching and supporting my channel. Good luck!

@@suemilkbone4868 yes, patients always have the right to refuse access, but it should be communicated to them what obstacles could occur with their treatment. Thanks for watching!!

I apologize, but I am not familiar with how to enroll a medical transportation company with CMS. I would recommend calling your local Medicare Administrator (MAC) and ask what is required to do so. They are usually very helpful. Thank you for watching!

Hi there- no, I do not. I have not created any commercial insurance specific videos because they are all different. Check out this link and it should help you with enrollment provider.humana.com/join-humana-network. Thanks for watching!

Hi there and thanks for watching! How exciting. Yes, that is most likely what they would do/how it should work. I encourage you to call his insurance and ask about their secondary coverage with your benefits as primary specifically. That way you’ll know for sure. Good luck!!

Thank you so much and I appreciate your support!! CLIA is only for laboratory tests. EKGs do not fall under that classification. Good luck!