Health Plans requesting copies of CMS letters

edited June 2017 in Part B Archive
I'm helping a large physical therapy group in Florida with their
re-credentialing.



I am noticing that many of the plans are also requiring a copy of the CMS
letter sent at the time of credentialing with Medicare, or when they
revalidate - something I haven't noticed before now, as most of my
credentialing work has been for Medicare through PECOS and not with other
plans.



I am guessing..... these requests might be because the plans may offer a
Medicare Advantage Plan.



Does anyone know?



Also, I was told by Medversant today (the company that credentials Florida
Blue providers) - that Florida Blue is requesting re-credentialing on *all*
providers currently. Anyone else running into this?



I am also finding out that re-credentialing requests are sent willy-nilly,
so I have taken the approach of saying *NO* to a request until the plan can
explain WHY they need it - the last date of credentialing, and what span of
time they require. I have caught a few sending requests that weren't
appropriate to re-credential.



Examples:



-the plan already received the information and I have a faxed receipt for
it, and



-a plan requesting re-credentialing data when it has already been done under
another plan umbrella (i.e. Optum) and there is no direct contract with the
requestor.



I am slo finding out how lucky I was to be in DC - MD - VA, as they have
very aggressive laws that protect providers from this type of burden.



Thanks,



Karen A. Hurley, BS, CMM, CPC, CNA

President, HPMSI

PO Box 409

Parrish, FL 34219

Tel: (941) 776-4822

Fax: (240) 368-0059

Web: www.hpmsi.com



Since 1996, Celebrating 20 years of Service to Physicians



Disclaimer: Advice or comments given in this email are specific only to the
recipient and the presented issue. It is not intended to be used as a
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Comments

  • Florida is a different animal- get used to it.

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  • edited June 2017

    LOL, I hear you...the good thing is the majority of my clients are
    elsewhere!



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219-0409

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



    Since 1996, Celebrating 20 years of Service to Physicians



    Disclaimer: Advice or comments in this email are specific only to the
    recipient and the presented issue. It is not intended to be used as a
    global solution for future similar events. Reproduction of the information
    requires approval by the author.



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