How can I add a new nurse practitioner to our Kids Health First contracts?
KHF does not credential nurse practitioners. Practices are to credential the providers on their or use an outside company.
Do not forget to that the nurse practitioner should also be credentialed through the state. Please also select the CMO option in the application if the practice accepts any CMO contracts.
KHF can add the nurse practitioners to our payor contracts after the credentialing process has been completed.
Please use this link to apply for a Medicaid number and opt in for CMO participation.
Does KHF help with contract, credentialing, and claim issues with BCBS and Amerigroup?
Practices are to credential with BCBS and Amerigroup independently as KHF does not hold a contract with either payor.
Because KHF does not hold contracts with BCBS and Amerigroup, we do not have a designated provider relations representative and do not have any power to escalate any issues.
Beyond general advice, KHF practices are to resolve BCBS and Amerigroup issues with their local representative and by calling the provider relation’s customer service number.
Can a practice appeal an unfavorable claim’s outcome?
Practices have the right to appeal with payors after having an unfavorable outcome but should do so with caution. Once an appeal process is started, it ties the hands of KHF and our assigned provider relations representative. It is equivalent to starting a legal process as it is heavily regulated.
A practice can submit as many claim’s reconsiderations as needed. As such, KHF advises that the practice reaches out to the payor and our provider relations team for assistance before submitted an appeal. We will work with the payor to assist with the issue.
It is very important that a practice follow the required appeal process as dictated by the payor. This includes using specific forms.
Does KHF participate with all plans with our contracted payors?
The answer is no.
The are several payors that administer plans as third-party administrators in which the network is not determined by the payor.
There are also several companies that will build their own network. These types of plans are often related to healthcare systems, unions, and self-funded groups.
Please have you staff always verify benefits and when in doubt call the payor and obtain a reference number or reach out to KHF for assistance. *The staff should not be relying on a payor logo found on the patient’s ID card to determine if the practice participated with a payor. *