How to Update Ownership and Legal Name Changes with Insurance Companies

A crucial part of your maintaining your operations is to update insurance companies when there's a change in name or ownership. Here are a few reasons why you need to keep your information up to date.

1.  Billing Accuracy: Insurance companies need the correct legal name and ownership details to process claims smoothly. Mismatches between the information on file and what's submitted can result in claim denials or delayed payments.

2. Regulatory Compliance: Insurance companies and regulatory agencies often require accurate, up-to-date information for credentialing. Changes in ownership, legal name, or structure might even trigger re-credentialing requirements, particularly with government payers like Medicare and Medicaid.

3. Network Agreements: Changes in ownership or name can affect existing contracts with insurers, requiring updates or renegotiations. Ownership changes may impact terms, reimbursement rates, or provider network status.

4. Continuity of Care and Patient Records: Ensuring accurate provider information not only helps patients locate their providers in insurance directories but also plays a vital role in maintaining consistent patient records under the correct entity name, thereby enhancing the quality of patient care.

5. Fraud Prevention: Keeping records updated helps insurers verify that claims come from authorized providers, reducing the risk of fraudulent billing.

In short, keeping insurers informed during name or ownership changes ensures a smooth transition, prevents revenue disruptions, and maintains compliance with payer requirements.

So here's how to Update Ownership and Legal Name Changes with Insurance Companies

Prepare Legal Documentation

1. Before approaching insurance companies, gather all the necessary documentation related to the change. These may include:

   • Articles of Incorporation or Amendment

   • Updated IRS documents (e.g., an updated W-9 form reflecting the new legal name or ownership structure)

   • State documentation reflecting the name or ownership change

   • Any required consents or agreements from previous and new owners, if applicable

Notify Relevant State Agencies

1. Depending on the state, you may need to update your provider's registration or license with state healthcare agencies before making updates with payers. Also, ensure your updated legal name and ownership information are reflected on your NPI location in the National Plan and Provider Enumeration System (NPPES) records.

Contact Each Insurance Company

1. For each payer, follow their specific guidelines for updating provider information. Most will require:

   • A completed provider update form

   • Supporting documentation, such as the legal documents prepared earlier

   • Confirmation of any tax identification number (TIN) changes or new tax forms

2. Each insurance company may have different forms or portals for updating provider data. Check the payer's website or contact provider relations to confirm the requirements.

Update Tax Information (if applicable)

1. If your legal name change also involves a change in tax ID, complete and submit an IRS Form W-9 to each insurance company. Some companies may have additional requirements for tax information changes if the change impacts billing practices or payment processing.

2. In some states and with some insurance companies, re-credentialing may be required after an ownership change, primarily if the change affects the company structure, tax ID, or the scope of services. Contact each payer to verify if re-credentialing or a new contract is needed.

3. Weigh the pros and cons of having a new Tax ID versus updating an existing one, as this will affect billing.

Submit Ownership Change Details

1. Ownership changes are typically more involved than simple name updates, often requiring additional approvals or agreements with payers. Be ready to provide:

   • A detailed letter describing the ownership change

   • Legal agreements between previous and new owners (often a purchase agreement)

   • Updates to the enrollment records in systems like NPPES, Availity, and other applicable sites/portals.

Follow Up

1. Processing times for updates can vary across payers. After submitting all required documentation, follow up with the insurance company's provider relations or credentialing department to confirm receipt and inquire about timelines.

2. Typically, following up every two weeks is recommended unless you receive a request for more information.

Review and Confirm Changes

1. Once insurance companies have processed the updates, review all official communications or updates to ensure the changes reflect accurately in each insurer's system. This can help avoid claim rejections or payment delays.

2. Note any effective dates of the change and relay them to your billing staff to avoid billing errors and denials.

Updating ownership and legal name changes with insurance companies can take time, so plan accordingly. Ensuring accurate and consistent updates across all relevant agencies and payers will help prevent disruptions in claims processing and revenue flow.

A well-coordinated plan with your team ensures a smooth transition during the update process. Clear communication will prevent delays and confusion from patient intake to claims processing.