Question 1

Why am I getting no patients from a plan I am in network with?

Accepted Answer

Usually members cannot find you or the plan cannot route them to you: a lapsed CAQH attestation, a missing or wrong directory listing, a not-accepting-new-patients flag, the wrong network program, or an NPI specialty code that does not match your license.

Question 2

How often must insurers verify their provider directories?

Accepted Answer

Under the No Surprises Act, at least every 90 days, with updates made within 2 business days of receiving a change.

Question 3

Is a discount program the same as being in network?

Accepted Answer

No. In a discount program the member pays you directly at a reduced rate and nothing is billed to the insurer, so it usually brings fewer patients than a covered benefit.

In Network but No Patients?

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