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07/23/2019

If an OD is licensed, but not yet credentialed by the insurance companies, can the new Dr. see patients without another OD present that is credentialed. Can they submit a claim under the credentialed

A: In order for a doctor to submit a claim to an insurance carrier other than Medicare or Medicaid, the doctor must be credentialed and contracted with the insurance carrier before submitting a claim. For Medicare and Medicaid some carriers will allow claims to be back dated starting one month after the Medicare application was submitted via PECOS and Medicaid is state dependent so you would have to check with the Medicaid carrier.

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