Credentialing question

We have a provider coming on board with uncertainty as to his start date, due to data found on his background check. However, I have all of the credentialing information needed to begin his applications.

If I select a start date at random (right now he is working as a locums through a certain date), say, November 1, and submit that on the 855R, is there any ramification if that does not end up being his actual start date? In other words, will they verify in some manner?

Renée McGowan
Credentialing Specialist

Renee McGowan
Credentialing Specialist

30 Burton Hills Blvd.
Suite 175
Nashville, TN 37215

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  • edited May 2017
    Not to my knowledge.

    In other words, you can have a start date - and from that point forward, he/she can see patients and submit and be paid to the group.

    I'm sure there have been many times a provider thought they could start on a certain date and it was later. If he/she is locum, claims aren't going under their name to the plan anyway, so I don't see a problem with that.

    I always ask for a copy of the signed employment agreement, so I have something to fall back on to prove the start date, rather than 'because I was told.'

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219
    Tel: (941) 776-4822
    Fax: (240) 368-0059

    Since 1996, Celebrating 20 years of Service to Physicians

  • Considering that many health plans do not start the provider on the
    effective date that you request and do not backdate. I would just give the
    provider the earliest date that you believe he/she will start.

    I just brought on a Nurse Practitioner with a clean profile who had already
    been credentialed through UHC, we were just working on the contracting. It
    took, literally, 6 1/2 months to finally get her finalized. She started
    with us on June 1st and will be able to see UHC patients on September 19th.
    I started working on her contracting/credentialing in March.

    Charlene Endre-Burgett, MS-HCM, CMA (AAMA), CPC, CMCS, CHM, CPOM
    Chief Operating Officer
    North Scottsdale Family Medicine

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