Kim: This is a problem that plagues many, if not most, hospitals. Technically, the physician shouldn't be treating patients if they are not credentialed, or treating Medicare patients if they don't have a UPIN/PIN.
Some hospitals I've worked with have just the opposite problem: they enter the physician into the Dictionary if they've been credentialed by don't have a UPIN/PIN yet. In these cases, we REJECT/Hold the claim because it is missing a UPIN/PIN; when the physician gets the PIN, the claim automatically drops. In your case, it sounds like your physician already has a UPIN/PIN. So in this case, you could probably enter the Physician into the Doctor Dictionary with his Medicare UPIN so that the electronic claim will generate correctly. Though, I'm not sure what the legal implications are if the physician is not credentialed in your organization or licensed in your state. In any case, these scenarios would seem to be an issue for Sr. Management to tackle; e.g., should they be allowing physicians to treat or refer Medicare patients to your organization if they are (1) not credentialed, or (2) don't have a UPIN necessary to be reimbursed for providing services to Medicare patients. Gary J. Ring Strategic Resource Group, Inc. 978-807-1573 ---- Original message ---- >Date: Wed, 18 Oct 2006 12:12:03 -0800 >From: "Kim Corrette" <[EMAIL PROTECTED]> >Subject: [MEDITECH-L] Medicare e-claim submissions for Providers not in >Provider dictionary >To: <[email protected]> > > Historically, our hospital has only entered > providers into the MIS Provider Dictionary after > they complete their credentialing process with us. > We are Magic 5.5 SR3 and use LSS. When a > non-credentialed provider sent us a Medicare > patient, we submitted the claim on paper and wrote > in the UPIN. Now that Medicare requires electronic > submission for all claims, how have other facilities > handled the submission of a claim for a provider who > is not in the Provider dictionary? The electronic > claim process pulls the UPIN from the Provider > Dictionary and does not allow other entries. TIA - > > > > Kim Corrette, RN > > Clinical Systems Analyst > > Bartlett Regional Hospital > > Juneau, AK > > (907)796-8838 > > > > > > > > >________________> > >====================================== >All messages should be posted in plain text. >HTML will be converted to attachments. > >The meditech-l web site is MTUsers.com >______________________________________ >meditech-l mailing list >[email protected] >http://mtusers.com/mailman/listinfo/meditech-l ====================================== All messages should be posted in plain text. HTML will be converted to attachments. The meditech-l web site is MTUsers.com ______________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l
