For healthcare providers, moving to a new state is an exciting opportunity for growth, but it comes with a complex administrative hurdle: Payer Credentialing and Contracting.
We frequently speak with providers who assume that their insurance participation travels with them. Unfortunately, the reality is often frustrating. In most cases, moving to a new state requires you to start the credentialing process entirely from scratch.
The "Start Over" Rule
When you relocate, you are essentially a new applicant in the eyes of insurance panels. Your existing contracts and credentialing files in your previous state generally provide no leverage in your new jurisdiction. To avoid significant disruptions in reimbursement, you must understand the specific requirements for each payer type.
Medicare and Medicaid: State-Specific Barriers
Medicare is a federal program, but it is administered regionally by Medicare Administrative Contractors (MACs). To bill for services in your new state, you must submit a fresh enrollment package for both yourself and your business entity to the local MAC to obtain new Provider Transaction Numbers (PTANs). This process typically takes 60 to 90 days.
Medicaid presents a similar challenge. Because each state operates its own unique Medicaid program, you must enroll separately in your new jurisdiction. While federal mandates have transitioned states to online provider enrollment portals, the process remains rigorous. Electronic submission does not always guarantee a fast turnaround; navigating unique state requirements can still be time-consuming, with approval times varying significantly from state to state.
Commercial Payers and Blue Cross Blue Shield
Commercial networks and BCBS associations are also state-specific. With very few exceptions for national PPO networks, you will need to undergo full credentialing and obtain a new participating provider agreement. This includes verifying your education, license, and malpractice history all over again.
Summary: Plan for Lead Time
The consensus across commercial and government payers is that the process is lengthy. Most commercial insurance credentialing takes 90 to 120 days.
If you are planning a relocation, do not wait until you have the keys to your new office. Begin your payer credentialing and contracting immediately to ensure you are in-network and ready to bill the moment you open your doors.
Don’t Let Red Tape Delay Your Opening Day
Navigating state-specific requirements is complex, but you don't have to do it alone. Kuka Consultancy can help provide guidance in your transition.
