It is important to understand that most providers are contracted as individuals and NOT contracted under a group contract. Instead, they are tied to a tax ID. So, MOST clinics are not considered IN or OUT of network, but ALL providers are.
Many providers erroneously think that IF they are IN network, their group is contracted and all they need to do is to ADD another provider to their group and that provider will be IN network as well. Obviously, that’s not the case.
Providers then decide they will “supervise” the work and/or sign off of the chart notes and bill under their NPI so the claims will be processed as IN network. This will not work either and can be considered fraud.
The new provider must contract individually with carriers to be IN network. If the provider is IN network with another group’s Tax ID, in some cases it is as easy as added YOUR tax ID to the individual’s contract. However, some carriers, (think BCBS) will require the new provider to re-contract with the new tax ID. It is important that you start this process early, contact every carrier and confirm their requirements. Then allow 60 days (or more) for the contracting to become official.