Approved Doesn't Always Mean You Can Bill

One of the biggest misconceptions I see is that once you're approved with an insurance company, you can immediately start billing.

That's not always the case.

This only applies to new contracts and newly credentialed providers. 

For new contracts, most insurance companies have a separate loading process that happens after your credentialing has been approved. During this process, they add your information to their claims system, including your NPI, Tax ID, practice information, fee schedule, and other billing details.

Until that process is complete, the insurance company's system may not recognize you as an active provider, even though you've been approved.

This is why providers sometimes hear, "Yes, you're approved," but then receive claim denials or are told by customer service that they can't find them in the system.

What About the Effective Date?

Your approval notice will include an effective date. This is the date you become an in-network provider under your new contract.

If you've already started seeing clients on or after that effective date, don't panic if you can't submit claims right away.

In many cases, you'll simply need to hold your claims until the payer finishes loading your information into their system. Once loading is complete, you can submit claims for those dates of service, as long as you're within the payer's timely filing limits.

The Welcome Letter

For many payers, the welcome letter is the best indication that the loading process has been completed and you're ready to bill. Some insurance companies send it directly to the provider, while others send it to the credentialing contact.