Editor's Choice Joining a Health Plan’s Network: Getting through the Medical Credentialing Process Health plans, or insurers, create networks of participating physicians, hospitals, labs, radiology facilities and other medical providers. These networks offer services to their members. Unlike hospitals, health plans do not grant privileges to physicians. However, the National Commission for Quality Assurance (NCQA) sets standards for credentialing physicians to join the health plan’s network. NCQA requires primary source verification of numerous physician credentials. Insurers verify ... Read More Understanding Medicare Credentialing Medicare remains the mother of all the credentialing systems in operation. And for good reason. For most practices, the majority of physician payments come from Medicare. Plus, more and more health plans are incorporating the same concepts as Medicare. With this kind of reach, you need to understand Medicare’s credentialing process to successfully run your practice. For most physician practices, Medicare requires three (3) basic applications. Medicare generated the 855 series of forms i ... Read More OIG Report on Incident to Billing The Office of Inspector General (OIG) report on incident to guidelines has a shocking headline.  In the sampled claims, "Unqualified nonphysicians performed 21% of the services that that physicians did not personally perform."  That is, physician employees performed invasive and non-invasive procedures that they were not qualified to perform, for which they had no documented training or credentials, and physicians billed Medicare and received payment for the services.  T ... Read More The mission of Codapedia™ is to build a community of volunteers (Codapedists) to create the world’s best and most comprehensive resource for coding and reimbursement for physician services.  Codapedia™ will be 100% free, with costs underwritten by advertising.