If secondary provider is out of network, so is their charge — but check state law first

Article Overview

This article explains general billing and reimbursement issues that arise when a secondary clinician involved in a procedure is not credentialed or contracted with the patient’s payer, even if the primary provider is in network. It covers payer network status, credentialing timing, possible out-of-network patient billing, and how state surprise-billing laws and federal proposals may affect these situations. The discussion is aimed at medical practice staff, coders, billers, and administrators who handle provider enrollment, claims, and patient billing.