• About
  • New Physician/Practice
  • Expanding Practice
  • Existing Practice Maintenance
  • Blog
  • Contact
Expedited Credentialing Services Expedited Credentialing Services
  • About
  • New Physician/Practice
  • Expanding Practice
  • Existing Practice Maintenance
  • Blog
  • Contact
Effective dates – will they be retro-active?

Effective dates – will they be retro-active?

May 31, 2016 Posted by Denise Stevens Uncategorized 3 Comments

The most frequently asked question we get from new providers joining an existing practice, or providers who are starting a private practice is “When can we schedule patients?”   Unfortunately, the answer is not black and white. There are many variables that go into determining an effective date.  Is the provider brand new to the insurance carrier or has he been credentialed before? If so, was it in the same state?  Just because Dr. Smith was in-network with United HealthCare in California will not mean that his credentialing in New Jersey will be backdated to the effective date he requests.

“But what about Medicare? They always backdate, right?” Medicare will honor an effective date that you request, as long as it’s within 30 days of the application receipt date.  (Keep in mind that you cannot request an effective date greater than 30 days in the future, either, as the application will be rejected.)  If there are any developments for corrections or additional information that are not responded to in the allotted timeframe, the application will be rejected and a new application must be submitted.  This decreases your chances of getting the effective date you originally requested.  Using a credentialing company who will stay on top of these developments will allow the application to process smoothly, assuring the practice that once the PTAN (Provider Transaction Number) is assigned, the claims for services rendered during the application process will be paid.

Many state Medicaid plans will backdate to your original requested effective date, but not all.  Commercial plans, on the other hand, are normally governed by committee meetings and contract executions.  If your practice has a group contract with a commercial carrier, the effective date may simply be the date the physician gets linked to the group contract in the carrier’s system.  If the provider must be individually contracted, you may be at the mercy of the work load of the contracting team, which could take anywhere from 30 days to 180 days – or more!

The unpredictability of effective dates can make setting up a brand new practice or adding a new physician to an existing practice very stressful.  It may be wise, for the sake of ‘good business’, to consider initial non-par write-offs as a business expense for a growing practice. You may be paid nothing, or you may be paid out-of-network rates, but you’ll keep the patients coming through the door while the credentialing and contracting process is wrapping up.  Make sure to refer to your credentialing reports for the status of each payer!

3 Comments
0
Share

About Denise Stevens

Before starting her own business, Denise was the Senior Payer Application Specialist at a specialty hospital in Rhode Island, responsible for maintaining the active provider enrollment status of approximately 400 providers. This included medical, behavioral and nutritional providers in a network of over 20 different insurance carriers throughout the New England states. Her primary responsibilities with ECS are credentialing team management, problem-resolution related to enrollment-based claim denials and training.

You also might be interested in

Linking an in-state provider to your group

Linking an in-state provider to your group

Jul 21, 2016

You hired a new physician. The practice he’s transferring from[...]

Have YOU checked your expirable documents lately?

Have YOU checked your expirable documents lately?

Jun 3, 2017

Who’s keeping an eye on your providers’ expirable data? What[...]

Why credentialing is the nightmare you never knew you had

Why credentialing is the nightmare you never knew you had

May 27, 2016

Your patient population is booming. You’ve had to hire a[...]

3 Comments

Leave your reply.
  • Natalie Murray
    · Reply

    January 8, 2017 at 6:26 PM

    Hello my name is Natalie Murray and I just wanted to drop you a quick message here instead of calling you. I came to your Effective dates post and found it very helpful. I have found that one of the keys to running a successful practice is knowing the ins and outs of the credentialing process. Kudos!

  • Antonia
    · Reply

    February 25, 2017 at 6:56 PM

    This blog was… how do I say it? Relevant!! Finally I have
    found something that helped me. Many thanks!

  • Stephani Kuhar
    · Reply

    August 22, 2017 at 4:37 PM

    Awesome post.

Leave a Reply

Your email is safe with us.
Cancel Reply

Contact Info

  • Expedited Credentialing Services
  • 1547 Fall River Ave; Bldg 3, Seekonk, MA 02771
  • 508.557.0322
  • 508.557.0131
  • info@ecscredhelp.com
  • https://expeditedcredentialingservices.com

Pages

  • About
  • Blog
  • Contact
  • Existing Practice Maintenance
  • Expanding Practice
  • New Physician/Practice

Recent Blog Posts

  • Have YOU checked your expirable documents lately?
  • Linking an in-state provider to your group
  • Medicare revalidations – again??
  • Work History – how important is it?
  • Effective dates – will they be retro-active?

What our clients are saying

  • “ECS’s outstanding professional credentialing services have made bringing in new healthcare providers much easier and has been very cost effective for my practice.”

    James E. Gilbert MD
    President and CEO, MOST Sports Medicine

© 2021 · Expedited Credentialing Services, LLC

Prev Next