Frequently Asked Questions

Once you are board approved you will receive a welcome letter to the contact email listed on your application. This will have your TIOPA Web View Portal login and link. The TIOPA Web View Portal is the best tool for viewing your current demographic information, viewing your participation status in the networks, and even modifying address locations, uploading renewed documents, and so much more.

Effective dates vary by plan. Our submissions representative sends out spreadsheets to the networks 10 business days after the board approval, as well as another around the third Friday of the month (but this can vary, due to holidays, etc.).  The networks then take 30-120 days to process the spreadsheet and send it back to us with the effective dates.

Reminder: any medicare networks require a Medicare PTAN for each provider under each TIN that you are practicing with and submissions cannot take place without the PTAN and the same for Medicaid plans and needing a Medicaid TPI. The count of days starts once the appropriate PTAN/TPI is received. Example: Board approved on Jan 25, 2021, the provider has medicare PTAN, but TPI is not received until Feb 9th. All commercial plans and Medicare plans will go on out to submission on Feb 5th, 2021 (10 business days after board), and the Medicaid lines of business will be on the submission sent on Feb 19th, 2021. 

You will not receive welcome letters from the networks. We submit the via spreadsheets and receive those back instead of individual applications files. Please use the portal as confirmation of participation.

 

 

Yes, we do, at an additional cost! Visit our Extra Services page for more details, pricing, and the online form. To sign up you will need a CP 575 letter from the IRS, a voided check, and a driver's license copy. Please be sure to have these items before completing the online form.

We do not assign associated reps for each provider. We all work collectively as a team with each of our members.

If you are wanting to add a new provider to become a TIOPA member, add an additional practice TIN,  find out about when a provider will go to the board, etc. please contact credentialing@tiopa.org

If you have questions regarding enrollment status with the networks, out of network issues, demographic questions, etc. please contact provider.relations@tiopa.org

Reminder: We do not assist with any billing questions unless it is a change of address. Please reach out to the network's claims departments or your billing company (if applicable) for denial issues. 

 

The network could state that you are out of network (OON) when you were verifying benefits if the group's NPI was used. You will need to always use the provider's individual NPI to verify benefits.

TIOPA does not enroll groups into the network. We enroll the providers and are linked to practicing TINs/NPI2s.

Please reference your welcome letter sent when board approved, the email sent confirming submissions, or the online web portal for an explanation of each of the network labels.

The most common question is PRV ACT RQD, which stands for "provider action required". We need the PTAN approval letter, TPI approval letter, or BCBS Provider ID that is required in order for submissions to take place.

To add a new location to a practice TIN that you are already approved with, you will need to log in to your WebView portal and make the necessary changes within the portal. It then gets placed in a queue and processed. You will receive an email if the change was rejected for any reason and the change will reflect in your portal upon approval of a TIOPA staff member. You can expect that the changes take 60-90 days to process with the networks.

If you need to add an additional practice TIN, please complete the form online and complete the necessary payment that is required for additional practices

Note: all of the enrollment dates start over with the new TIN and you more than likely will not have the same effective dates for your new group. The entire process starts again at this time, also meaning you will need another PTAN, TPI, and BCBS number for your new practice. 

 

Please make sure that you have an NDA on file with us. Please reach out to credentialing@tiopa.org for further confirmation.

You can access the fee schedules link from your WebView portal or on the provider resources page.

No, not to be a TIOPA member, but you will need to complete the provider relations packet in its entirety so that we have hospital coverage letters on file for the networks that do require them.

Certain networks can deny participation status, at their discretion without certain in-network hospital privileges, even with a hospital coverage letter.

This is dependant on how clean a file is submitted. Most membership applications are processed in 30-45 days for them to be sent to the board. Once board approval, then 10 days to the network submissions. If we are completing the extra service enrollments for Medicare, Medicaid, and BCBS, then BCBS averages 30-50 days, Medicare is 30-90 days, Medicaid is 30-90 days, and total time for extra services takes an averaging about 75-100 days, depending on services requested. The networks take 30-120 days to process approvals.

So, in short, the average time is about 4-6 months to become board approved and have effective dates with 90% of the plans, depending on what plans you have opted into and services you have requested.

New member application fees:

Application Fees - MD, DO, DPM, DDS, OD, DC, DPT $850
Application Fees - Allied Health Professionals $550

Additional TINs: $350 per provider

Annual Dues:

MD, DO, DPM, DDS, OD & DC. $950
Occupational Therapists & PT (including DPT for annual dues) $750
Allied Health Professionals (RN, NP, PA) $750
Licensed Professional Counselor, Ph.D., Registered Dietitian $750
Additional TIN charge for members $100 each TIN

Recredentialing Fees: 

All Providers $350 per TIN

Extra Services: 

CAQH Maintenance - $150 annually

Existing Practices - 

Medicare $250

Medicaid $250

BCBS $150

RailRoad Medicare $100

Full-Service Bundle $650 (Save $100)

New Practices - 

Medicare $600

Medicaid $800

BCBS $150

RailRoad Medicare $100

Full-Service Bundle $1500 (Save $150)