A board certified anesthesiologist and addiction medicine specialist wanted to be enrolled with BCBS and United Healthcare. However, the American Board of Addiction Medicine is not a member of the American Board of Medical Specialties (ABMS). The process to bring addiction medicine into the ABMS as a multi-specialty subspecialty, through sponsorship by the American Board of Preventive Medicine, began in February 2015. However, most plans do not recognize multi-specialty subspecialty as a board certified specialty. Therefore, the plans wanted the client to be credentialed in their behavior health program. The client, and the specialty itself, insisted it was a medical specialty.
The following was conducted:
Phone calls to the two insurance companies;
Research on the specialty and the board; and
Research on BCBS and United Healthcare rules concerning multi-specialty providers.
The client’s contracting with STAT resulted in BCBS approving the provider as a multi-specialty specialist in medicine. STAT was able to leverage BCBS’s approval to obtain United Healthcare approval.
The client is now receiving reimbursement from two primary payors in his market.
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