FAQ

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This varies by each Insurer. It typically takes 40-65 days. This is 40-65 days from the time of Demographic Change Request Submission. 

Join Genesis

1. Phase 1: The initial step is the Application Completion process. We make this process as seamless as possible, so you don’t have to fill out duplicate applications.
   • You will get a link to a portal. You will sign into your CAQH account, update and attest your CAQH profile.
   • After you have updated your profile, we will have secure access to the necessary information to create the Texas Standardized Credentialing Application (TSCA).
   • Next step in this first phase, is for us to start the credentials verification process in accordance to NCQA, CMS, and Health Plan guidelines.
   • After this comprehensive verification is done, your file will go to our Peer Review Committee for their review and approval.
   • After Peer Review Committee approval, you will get a notification that your credential verification is done and Genesis Health Plan enrollment team will take over. This initial phase is significantly dependent upon how quickly you are able to accurately update and attest your CAQH profile. Our goal is for this initial process not to take more than 30 days.
2. Phase 2: The Second Phase is Health Plan enrollment with the goal of obtaining effective dates so you can compliantly see patients and submit bills to Health Plans for reimbursement.
   • Turnaround time for each health plan varies. After Genesis’ Peer Review Committee approval, health plans can take up to 145 business days to issue effective dates. Many health plans back-date the effective date to when we submit the information but there are no guarantees on this.

Physical Therapists, Occupational Therapists, Speech Therapists, Optometrists, Dentists, and Chiropractors

Supervising MD must be credentialed by Genesis Physicians Group and enrolled in the same plans. See guidelines from TMB: TMB’s requirements for Physician Supervision and Prescriptive Authority Delegation

Requirements for Supervising Physicians

Genesis currently does NOT offer Medicaid and Medicare Enrollment and Revalidation services. We used to offer this service for an additional fee in the past. We will be reviving this service in the near future if there is enough interest from Genesis members.

For Medicaid and Medicare enrollment please refer to the following instructions:

For Medicaid: Please go to Texas Medicaid Healthcare partnership site: www.tmhp.com log into your account and follow the instructions to revalidate.

For Medicare: Please go to PECOS (Medicare Provider Enrollment, Chain, and Ownership System) site: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1 log into your account and follow the instructions to revalidate.

Checklist for Individual Physician and Non-Physician Practitioners using PECOS

• PECOS Individual Physician or Non-Physician Practitioner Checklist PDF Download

Checklist for a Provider or Supplier Organization using PECOS

• PECOS Provider or Supplier Organization PDF Download

The answer is No and here is why:

Genesis Physicians Group IPA operates under a “Messenger Model”. A Messenger Model IPA cannot negotiate contracts with health plans on your behalf. Essentially, the Federal Trade Commission (FTC) restricts IPAs from coordinating or negotiating pricing and other contractual terms among its members to prevent price fixing, antitrust issues and potential penalties. 

In simple terms, while our IPA can help communicate or “message” contract offers between you and the payors, we must not discuss or influence the terms, including prices, on which you decide to deal with these payors.

Engaging in any of these restricted activities could lead to legal actions and significant penalties, as highlighted in FTC cases like the one involving San Juan IPA. This incident highlights the importance of adhering to the stipulations set by the FTC to avoid antitrust issues and potential penalties as mentioned above.

For detailed guidance and more on the FTC’s policies regarding the messenger model, you can refer to the FTC’s official documentation and consent orders that provide comprehensive explanations and examples of permitted and prohibited activities.

Reference: FTC guidance against Messenger IPAs’ ability to engage in negotiations

CAQH, or the Council for Affordable Quality Healthcare, is a nonprofit alliance of health plans and related organizations in the United States. Its primary purpose is to streamline administrative processes in the healthcare industry to make them more efficient, cost-effective, and less burdensome for both healthcare providers and health plans.

CAQH is important for several reasons:

1. Credentialing and Provider Data Management: CAQH operates a centralized database where healthcare providers can securely store and maintain their credentialing and provider data. This eliminates the need for providers to submit redundant credentialing paperwork to multiple health plans and organizations.

2. Efficiency: By using CAQH, providers save time and effort when applying for network participation with various health plans. It simplifies the process, reducing administrative overhead and paperwork.

3. Accuracy: The database helps ensure that provider information is accurate and up to date, which is crucial for Credentials Verifications Organizations (CVO) such as Genesis Physicians Group to verify the qualifications of our members to effectively enroll you in health plans.

4. Compliance: Many states, including Texas, require the use of standardized credentialing applications like the Texas Standardized Credentialing Application (TSCA). CAQH helps providers meet these compliance requirements by providing the necessary standardized information.

In summary, CAQH plays a vital role in streamlining administrative processes, improving data accuracy, and reducing administrative burdens in the healthcare industry, making it an essential tool for both healthcare providers and Genesis Physicians Group’s Credentialing and Provider Enrollment team.

Genesis’ responsibilities don’t end after health plans’ effective dates are obtained. Our 18+ health plans require us to do ongoing monitoring of sanctions, National Practitioner Data Base, etc. and provide them regular reports. This ongoing monitoring is an essential responsibility for our team to ensure you don’t have any lapses in your health plan enrollment to avoid any interruption in the flow of your revenue.

In addition to the responsibility of ongoing monitoring, we undergo audits by health plans annually.

As you can imagine this is a cumbersome process. Based on the result of the audit we modify our credentialing policies and procedures annually. In addition to multiple health plan audits we undergo an extensive NCQA audit every other year. The NCQA audit takes 3 to 4 months to complete. As a result of the NCQA audit, we modify and update our policies and procedures.

Every three years we re-credential our members based on regulatory compliance requirements. The process includes primary source verification of credentials ensuring all of the physician’s credentials such as malpractice, DEA, licenses, etc. are up to date.

We do not provide Revenue Cycle Management services. We are not able to assist with claims questions unless it is regarding network status (claims processed as out of network), fee schedules, or demographic issues (locations not listed with the plans).

Genesis Agreements with Health Plans do not have hard expiration dates. They are essentially evergreen and auto-renewing. As a messenger IPA model, by law we are not allowed to negotiate rates.

Almost all the contracts state that fee schedules can be “updated periodically” by the plan. In fact, It is quite common for fee schedules to only change every few years with the exception of addition of newly published codes or new drugs/injectables which are updated more frequently.

Genesis does NOT hold the Health Plan agreement directly with United Healthcare.

Instructions On How to Contract with UHC.

Per United Healthcare’s policy, they contract directly with you as the Healthcare Provider. They do delegate the credentials verification and ongoing monitoring to Genesis. You MUST contact UHC (Michelle Antisdel at michelle_antisdel@uhc.com or call (952)202-7101) with any and all topics outlined below: 

• If you have United Healthcare Contract questions.
• If you have United Healthcare Network questions, please contact United HealthCare via the following: networkhelp@uhc.com.
• UHC Network questions may include:
  • Fee schedule requests
  • General contracting questions:
    • Use your One Healthcare ID to access Network Help and Support and chat with an advocate.
  • Network availability and product participation
  • Status of provider/contract load
  • WellMed related contracting and enrollment questions

• Need support for UHC provider portal, claims, prior authorization or eligibility and benefits? Sign into the UnitedHealthcare Provider Portal to chat with a UHC service advocate.

If you have demographic updates to your practice, it is absolutely essential to follow the below 2 steps:

• Step 1: Go to Genesis Support Desk (office locations, phone numbers, Tax IDs, credentialing contact)
• Step 2: Please sign into your CAQH profile and update your demographics.  

In 2022, UHC introduced the Exchange Network as a new offering. Providers chosen to participate received notification letters along with an Amendment to their contract. UHC selected the providers included in the Exchange network through direct agreements with those providers.

Key Points to Note:

• UHC’s selection for this plan was specific and not open to all providers.
• If you haven’t received communication about this plan, you are not part of the in-network.
• Regrettably, Genesis does not have the capability to enroll you in this plan.

Please note that the current enrollment period for the exchange plan has ended. UHC conducts an annual review of the network and will send out amendments to selected providers for inclusion in this plan.

Use the following link:Fee Schedule Lookup Quick Start Guide – UnitedHealthcare Commercial Plans (uhcprovider.com)

• Need support for UHC provider portal, claims, prior authorization or eligibility and benefits? Sign into the UnitedHealthcare Provider Portal to chat with a UHC service advocate.
• Need help with contracting? Use your One Healthcare ID to access Network Help and Support and chat with an advocate.

Click on the following link to sign in and access your provider portal: Synergy

Click on the following links:

CMS Fee Schedule Link

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth

Lab services are excluded per the contract with Care N Care. Patients must be referred to participating labs. In network labs can be found using the link below:

Care N Care In-Network Labs

• PCPs and Specialists:100% of CMS by locality
• Mid-levels: Typically, lesser of 80% of the actual charge or 85% of the physician allowable under the Medicare Physician Fee Schedule.
• Are the HMO and PPO plans reimbursed at the same rates? Yes