Can I submit insurance claims electronically if I'm out of network?
Maybe; some payers do allow this. A rule of thumb is that if it is a government payer than you need to be credentialed in order to submit claims electronically. This is because additional enrollment needs to be completed for government payers and the payers will not approve the enrollment if you are out of network with them. Some commercial payers do not care if you are credentialed with them or not and will accept electronic claims without being in network.
To find out a particular payer's policy, contact ApexEDI directly, M-F 10am-7pm ET, at (800) 840-9152.
If you have any questions, please contact us.