Very few insurance companies will pay for care that has been provided by a doctor not yet established as a credentialed member of the plan’s provider panel. When a provider is awaiting credentialing, you are not able to bill for services using locum tenens or reciprocal billing procedures.
Given the financial impact that this can have on the practice, it can be tempting to bill for services under the NPI of another doctor in the practice. However, it is our opinion that the risks associated with this outweigh the benefit. One call to an insurance company from a patient who noticed that their EOB listed doctor A as the provider when they know they saw doctor B would create the opportunity for exploration of insurance fraud.
In the case of a doctor not yet credentialed with a particular plan, the prudent approach is to contact the plan to determine if they allow billing for care provided by doctors outside their panel of providers. If the answer is "no." it is safest to have the doctor limit their services to self-pay patients and other tech-related activities until the credentialing process is complete. Following this procedure allows the practice to know that they are following the letter of the law and, in turn, limiting financial risk.