How Providers Can Work Across Multiple Practices Successfully

If you’re a medical provider thinking about working for multiple practices or a practice manager curious about how it works—good news! Providers can work for different, independently owned medical practices simultaneously. The key to success is keeping contracts, credentialing, and billing separate for each practice. Let’s explore juggling multiple roles without the chaos or claim denials.

Key Takeaways:

Providers can work for multiple independently owned practices, but clear contracts and separate credentialing are a must.
Each practice needs its own billing setup using the provider’s NPI-1 tied to the group’s NPI-2 and Tax ID.
A credentialing tracker and regular payer follow-ups can prevent billing delays or denials.
Educate patients on billing processes to avoid confusion when seeing a provider at multiple locations.
If running a side practice, keep it separate by using a personal Tax ID or Social Security Number.

How Working for Different Practices Works

When discussing providers working for multiple practices, we’re not referring to a single business with multiple locations. We’re talking about entirely separate business entities. For example:

A provider works at Practice A (owned by Business A).
The same provider also works at Practice B (owned by Business B).

Here’s the key: Each practice must have its contracts, credentialing setup, and billing processes for the provider. You can’t “carry over” contracts or affiliations from one business to another. It’s a fresh start for each practice, even though the provider’s NPI-1 (Individual National Provider Identifier) stays the same.

The Credentialing Process for Multiple Practices

Credentialing is the foundation of ensuring providers can work at different practices without issues. Here’s how it works:

1. Each Practice Needs Its Own Contract

Picture each practice like a separate umbrella. Beneath each umbrella is the NPI-2 (Group National Provider Identifier), Tax ID, and the associated providers.

When a provider joins a practice, their NPI-1 (Individual) must be affiliated with the group’s NPI-2 and Tax ID for that practice. This ensures that when claims are submitted, the payer can verify that the provider is officially credentialed under that practice’s contract.

2. Affiliating the Provider Under the Group

Affiliation involves tying the provider’s NPI-1 to the group’s NPI-2. For example:

When billing for Practice A, claims will include Practice A’s Tax ID and NPI-2, as well as the provider’s NPI-1.
When billing for Practice B, claims will include Practice B’s Tax ID and NPI-2, along with the provider’s NPI-1.

This separation keeps everything clean and ensures proper reimbursement. If a provider isn’t correctly affiliated with a group, claims may be denied with errors like “Provider not linked to group.”

3. Confirming with Payers

After completing credentialing, always confirm with the payer that the provider has been properly linked to the group’s contract. This step ensures everything is set up in the payer’s system before claims start flowing in.

Medical Credentialing Process: What Every Provider Needs to Know

How Billing Works for Providers at Multiple Practices

Billing can be a bit tricky, but as long as you follow best practices, it’s manageable.

Billing Under Group Contracts

When a provider renders services at a practice, claims must be submitted under that practice’s group information. This means:

The Tax ID and NPI-2 of the group are used to indicate the billing entity.
The provider’s NPI-1 is included to indicate who rendered the service.

In claims (whether submitted via paper using the CMS-1500 form or electronically via an ANSI file), these details work together to show the payer:

The group under which the services were billed.
The provider who performed the services.

What Happens If They’re Not Properly Linked?

If the provider isn’t affiliated with the group in the payer’s system, claims might be denied with errors like:

“Provider not credentialed with the group.”
“Provider not found under a group contract.”

These denials indicate that something is missing in the credentialing process, and you’ll need to contact the payer to resolve it.

What About Providers with Their Own Side Practice?

Sometimes, a provider may want to have their practice on the side while working for one or more group practices. This can also work perfectly fine as long as everything is kept separate.

How Individual Billing Works

When a provider bills for their services (outside of a group), they can do so using their NPI-1 and Social Security Number (or EIN if they set up an LLC or sole proprietorship). In this case:

Claims will list the provider’s details as the billing entity and the rendering provider.
The Social Security Number or EIN will act as the Tax ID, making it clear that this is a separate, standalone entity.

This separation ensures that payers can distinguish between services rendered under the provider’s practice and those billed under a group practice.

The Importance of Clean Contracts and Credentialing

The common thread here is organization. Each practice must have its clear contracts, credentialing records, and billing setup for the provider. Mixing up Tax IDs, NPIs, or group affiliations can lead to denied claims and compliance issues.

Quick Checklist for Practices

Separate Contracts: Ensure the provider is contracted under each group’s Tax ID and NPI-2.
Credentialing Confirmation: Verify with each payer that the provider has been correctly linked to the group.
Accurate Billing: Ensure claims are submitted with the correct group information for each practice.

Key Takeaways for Providers Working at Multiple Practices

Working for different medical practices simultaneously is not only possible but also common. However, providers and practices must keep their contracts, credentialing, and billing processes separate and well-organized to avoid issues.

Whether the provider is affiliated with multiple group practices or running their own side business, the golden rule is: Keep it separate, keep it clean, and always confirm with payers.

With the right setup, providers can navigate multiple affiliations smoothly, ensuring their claims are processed correctly and efficiently.

Navigating Multi-Practice Contracting, Credentialing, and Common Pitfalls

Now that we’ve covered the basics of working for multiple medical practices and keeping everything separate let’s dive deeper into some advanced tips and common challenges. If you’re managing or working as a provider juggling multiple affiliations, knowing how to handle the finer details of credentialing, contracting, and billing can save you countless headaches. Let’s break it all down.

The Contracting Maze: Keeping Agreements Clean Across Practices

When a provider works for multiple practices, contracts are your compass. They ensure no confusion or overlap between the parties involved and establish clear terms for each business arrangement.

Here are some important factors to consider:

1. Separate Contracts for Separate Practices

Each practice the provider works for must have its unique contract. These contracts define the provider’s relationship with the business and clarify how they’ll be paid, how their services will be billed, and who’s responsible for credentialing.

For Practice A, the contract might state that the provider works 20 hours a week and that the practice pays all credentialing fees.
For Practice B, the provider might work per diem, covering any fees related to adding them to payer contracts.

Keeping these contracts clean and separate prevents misunderstandings and ensures no legal or operational overlap.

2. Billing and Revenue Split Agreements

If a provider’s services generate revenue for the practice, the contract must clearly define how this revenue is split. For example:

Does the practice take a percentage of collections?
Does the provider receive a flat hourly fee, or are they paid a percentage of their claims revenue?

With multiple practices involved, ensuring that each contract outlines revenue arrangements is important to avoid double billing or disputes over who gets paid for which patients.

3. Non-Compete Clauses

Ah, the dreaded non-compete clause is something every provider working for multiple practices should carefully watch out for.

Some practices include non-competes in their contracts to prevent providers from working for competitors in the same geographic area. This clause can create major legal issues if a provider juggles multiple roles.

Red Flags: Watch for restrictive clauses that block a provider from working for another practice.
Negotiation Tip: Work with a healthcare attorney to negotiate the terms, ensuring the provider has the flexibility to work elsewhere.

Advanced Credentialing: How to Avoid Payer Denials

Credentialing is the foundation of billing, and when a provider works for multiple practices, getting credentialing right becomes even more critical. If payers can’t verify the provider’s affiliation with a group, claims will be denied, and cash flow will halt.

1. Double-check the Payer’s Credentialing Process

Every payer has a process for adding providers to a group. While some are straightforward, others can be time-consuming and overly complicated.

Be Patient With Small Payers. Regional or local payers often require more paperwork and manual processing than national payers like Aetna or Cigna.
Don’t Assume Anything: Even if the payer says the provider is linked, request confirmation in writing. Mistakes happen, and it’s better to be proactive than reactive.

2. Follow Up Religiously

One of the most common pitfalls with credentialing is assuming everything is complete after the paperwork is submitted. Unfortunately, payers can take weeks—or even months—to process credentialing requests, and errors can further delay the process.

Weekly Follow-Ups: Assign someone in your office to regularly check in with the payer. Don’t assume silence means progress.
Track Status: Keep a spreadsheet of credentialing statuses for each payer and practice to ensure nothing is overlooked.

3. Keep NPI Numbers Consistent

Providers have two critical NPI numbers to manage:

NPI-1: This is the provider’s individual identifier and stays the same no matter how many practices they work for.
NPI-2: This is the group’s identifier, which changes for each practice the provider works with.

When submitting claims, ensure the provider’s NPI-1 is correctly linked to the NPI-2 and Tax ID for the specific group contract. If these numbers don’t match in the payer’s system, claims will bounce back faster than you can say “denied.”

Common Pitfalls When Working for Multiple Practices

Providers working at multiple medical practices often run into similar challenges. Here’s how to avoid the most common pitfalls:

1. Double Billing

This occurs when a provider mistakenly bills the same service under multiple practices due to overlapping schedules or improper claim submissions.

Solution: Use a centralized scheduling system that tracks where and when the provider rendered services. This prevents accidental overlaps and keeps the billing clean.

2. Lack of Transparency With Patients

Patients who see a provider at multiple locations may get confused about billing. For example, a patient might assume they’re being billed by the provider directly, only to find out later the claim went through one of the group practices.

Solution: Educate patients about which practice will handle their billing and ensure the provider’s name and NPI are correctly reflected on claims and invoices.

3. Overlapping Credentialing Timelines

When a provider is credentialing with multiple payers across different practices, it’s easy to lose track of where they’re approved for billing.

Solution: Create a credentialing tracker that lists:

The payer.
The practice name.
Credentialing status (submitted, pending, approved).
Effective dates.

This ensures that providers only bill under contracts where they’re fully credentialed and avoids denials for “unaffiliated provider” errors.

Key Considerations for Providers Running Their Side Practice

If the provider wants to keep their private practice in addition to working for multiple groups, the rules are slightly different. Here’s what to keep in mind:

Tax ID and Billing Clarity

For their side practice, the provider can use their Social Security Number as the Tax ID (if they’re a sole proprietor) or obtain an EIN if they form an LLC. This ensures their private practice remains separate from the group practices they’re affiliated with.

When submitting claims:

Use the provider’s individual NPI-1.
Use the Social Security Number or EIN as the billing entity.

This keeps private practice revenue completely independent from the group practices and ensures no mix-ups with payers.

Why Organization is Everything

Let’s face it—working for multiple practices can feel like juggling flaming torches if you’re not organized. Contracts, credentialing timelines, payer follow-ups, billing processes… it’s a lot to handle. But with the right systems in place, it’s doable.

The secret? Stay proactive and detail-oriented. A good credentialing tracker, clear contracts, and regular follow-ups with payers will save you time, money, and stress.

FAQ

Can Providers Work for Multiple Medical Practices?

Yes, providers can work for multiple independently owned practices simultaneously. However, each practice must maintain separate contracts, credentialing, and billing processes to avoid co-mingled operations and ensure compliance.

What Does It Mean to Work for Different Practices?

This refers to working for separate business entities, not multiple locations of the same business. Each practice must have its own contracts, credentialing setup, and billing processes for the provider.

How Does Credentialing Work for Providers at Multiple Practices?

Each practice must affiliate the provider’s NPI-1 with its NPI-2 and Tax ID. This ensures the provider is properly linked to the group’s payer contracts, preventing claim denials due to credentialing issues.

What Happens If Credentialing Is Not Set Up Correctly?

Improper credentialing can lead to claim denials with errors like “Provider not linked to group.” Always confirm with payers that the provider is correctly credentialed for each practice before submitting claims.

How Does Billing Work for Providers at Multiple Practices?

Billing must reflect the specific group under which services were rendered. Claims include the group’s Tax ID and NPI-2, along with the provider’s NPI-1, ensuring clear payer identification.

Can Providers Have Their Own Side Practice?

Yes, providers can maintain a private practice while working for group practices. Claims for the side practice should use the provider’s NPI-1 and either their Social Security Number or EIN for clear separation.

Why Are Separate Contracts Important for Providers?

Each practice should have its own contract with the provider to define terms like hours, credentialing responsibilities, and revenue arrangements. This avoids legal and operational overlap.

What Are Non-Compete Clauses and How Do They Affect Providers?

Non-compete clauses restrict providers from working for competitors in the same area. Providers should negotiate these terms to maintain flexibility while ensuring compliance with contract agreements.

What Are Common Pitfalls of Working for Multiple Practices?

Challenges include double billing, overlapping credentialing timelines, and patient confusion about billing. Clear contracts, credentialing trackers, and patient education can avoid these.

Why Is Organization Crucial for Providers Working at Multiple Practices?

Effective organization prevents billing errors, credentialing delays, and compliance issues. Using credentialing trackers, maintaining separate contracts, and confirming with payers ensures smooth operations across practices.

Successfully Managing Multiple Medical Practice Roles

Working for different medical practices simultaneously is a fantastic opportunity for providers, offering variety, flexibility, and the chance to broaden their career horizons. However, success hinges on one critical factor: organization. Keeping contracts, credentialing, and billing processes cleanly separated between practices is essential for avoiding claim denials, compliance headaches, and unnecessary stress.

Providers can seamlessly navigate multiple affiliations without issues by ensuring each practice maintains its distinct payer contracts and credentialing setup. Whether you’re managing providers or you’re the provider yourself, having clear contracts, detailed credentialing trackers, and proactive payer follow-ups will set you up for success.

For providers who want to maintain a private practice alongside their group affiliations, keeping things independent with a dedicated Tax ID or Social Security Number simplifies everything further. This separation ensures smooth billing and helps avoid the pitfalls of overlapping or double billing.

At the end of the day, attention to detail is the key to juggling multiple practices. Establish your processes, monitor credentialing timelines, and communicate clearly with payers, patients, and practices. Working for different medical practices can be a seamless, stress-free, and gratifying experience.