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Engaging Safety Net Providers in Expanded Coverage: Tips on Enhancing Billing Capacities

Engaging Safety Net Providers in Expanded Coverage: Tips on Enhancing Billing Capacities

June 2013
National Academy for State Health Policy

Description

Steps for safety net providers to take in preparing for third-party reimbursement.

Steps include:

  • Enroll in Medicaid and CHIP. Providers cannot bill these payers if they are not enrolled, according to state-specific processes.
  • Learn Medicaid essentials. Which services are billable, require prior authorization, etc.
  • Get credentialed and contract with health plans. Review and meet credentialing standards, which may vary across health plans, and contract with health plans as an Essential Community Provider (ECP). 
  • Ensure eligible clients are enrolled in coverage. Providers cannot bill Medicaid and CHIP if clients are not enrolled. 
  • Seek feedback from third-party payers. Initial bills may get rejected. Providers need to learn how the system works.
  • Ensure appropriate administrative capacity. Staff will be needed to handle billing. Is your agency ready to expand staffing?
  • Assess whether to develop billing capabilities in-house. Hiring new staff is one option, but outsourcing is also a valid response.

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