Keeping Information Up to Date with Insurance Companies

Karen Lee

Did you know that how you are credentialed with an insurance company can directly impact the type, amount, and frequency of clients you see? Did you also know that failure to keep your mailing address up to date with insurance companies can delay claim payments from reaching your practice? Or, did you realize that a change in practice address can cause claims to be denied completely? Many providers do not realize the impact changing information can have on their provider profile with insurance companies. While some can have no impact at all, often, the impacts can be very devastating if not addressed immediately.

When a provider joins an insurance panel they are “Credentialed” or contracted with the insurance company. At the time of contracting, important practice information is verified: tax-id, NPI, practice address, mailing address, billing address, and more. At any time should a provider wish to change their practice address, change their tax-id or NPI, or request mail and payments begin being sent elsewhere changes must take place. These changes can take a minimum of thirty (30) days and a maximum of six (6) months to complete. It is for this reason that providers should notify insurance panels as soon as possible if they are aware a change will take place.

While a change is taking place, there is a possibility that claims can be denied, delayed, or frozen. Not only can a change impact claim payments and denials, but if a claim does get paid it can result in funds being lost. Additionally, providers may find that prospective clients who call to schedule appointments are no longer interested because the practice is too far from their home address. Imagine how frustrating and time consuming it is to have a patient call only to find out your practice is over thirty (30) minutes from their home.

There have been instances of providers being delayed payment by insurance companies for up to six (6) months from the date of service because their practice or payment address has changed. The common situation in this instance is as follows: claim is submitted. Claim is paid, check is mailed. Mailed check is delivered to old address on file, but provider is no longer there. Mail is then returned to the insurance company for bad address. The provider then must call and update the information on file. Once the information is updated (which can take a minimum of thirty days) then a new check must be mailed. Once the check is mailed it can take 7-10 business days to reach the new practice address. This process then must be repeated with any claim submitted between the original date of service and the time the provider called to update the information on file. What a mess!

To avoid issues in the future, follow these simple steps:

  1. Try to change practice addresses as few times as possible
  2. Always use a permanent base for mailing and payment addresses (like a home, business office or PO Box)
  3. Call to inform insurance companies of the change to demographic information 30 days prior to the change taking place
  4. If claim payments will be delayed or frozen: set extra funds aside to cover the difference.

If you are concerned about your practice, or would like peace of mind knowing there is someone available to take care of this process for you, contact a Ponderosa billing agent today!