Provider Frequently Asked Questions

Who is Networks By Design and is NBD owned by another PPO or entity?
NBD is an independently-owned EPO network domiciled in California. The corporate office is located in the Central Valley of California.

NBD’s objective is to "get back to the basics" by developing and providing a customized, quality provider network in California. NBD’s objective is to promote strong steerage to network providers through plan and network designs. NBD is committed to our network providers and clients and will always strive to provide superior customer service.

How do I obtain an NBD Agreement and Application to join the NBD Network?
Join the Network and complete the provider nomination form. We will send you an application and NBD Agreement within 48 hours via e-mail (if provided) or first class mail.

How do I check on the status of the Agreement and Application I submitted to NBD?
You are welcome to contact us for the status or you may call us at (209) 229-8537.

May I submit a completed CPPA application or CAQH profile already on file at my office or do I need to complete the CPPA and Addenda enclosed with the NBD Agreement?
Yes, you may submit a completed CPPA app. or CAQH profile if less than 6 months old. Please ensure all requested current copies of documents (i.e., state medical license, professional liability insurance certification, curriculum vitae, board certificate ( if applicable), to enable NBD to complete the credentialing process.

We represent a medical group/IPA and want to have delegated credentialing in place with PPO networks. Is NBD agreeable to delegated credentialing?
Yes, NBD is willing to allow medical groups/IPAs to be delegated for credentialing. NBD will need a copy of the medical group/IPA’s credentialing policies and procedures. Once NBD reviews the policies and procedures, if acceptable, NBD will send a Delegated Credentialing Letter of Agreement (LOA) for both parties to sign stating the attached policies and procedures are acceptable and group agrees to notify NBD if there are any material changes to Credentialing policies and procedures. NBD reserves the right to terminate the Delegated Credentialing LOA based on any material changes.

What if I only wish to be in the Workers’ Compensation MPN Network?
If you only treat workers’ compensation injuries and do not wish to provide services to patients in group health plans, please send a statement in writing along with your completed application and NBD Agreement. We will honor your request.

How do I update my provider file with NBD?
You may e-mail your updates/changes and NBD will update your file within 20 days from receipt of the e-mail. You may also fax your updates/changes to Network Development at (209) 879-9387.

How do I identify NBD clients?
The NBD name and logo will be identified on the member’s group health plan identification card or other form of identification provided by the member. For workers’ compensation Medical Provider Network (MPN) clients, you will receive notification/authorization prior to treatment of the injured worker.

Where do I send my claims for NBD clients?
The members should present with an identification card which lists the address for claims submission.

What if I have a claims payment issue with a Payor?
If you are unable to quickly resolve the issue directly with the Payor, please contact NBD’s Provider Relations team at (209) 229-8537 for prompt assistance and resolution.

How do I obtain a copy of my current contract with NBD?
You may request a copy of your NBD Agreement by Contacting Us. We will forward you a copy via e-mail (if provided) or fax.

Will you be recruiting every provider in my region?
No. NBD’s "back to the basics" approach will not include all providers. NBD wants to encourage the channeling of patients to network providers to support a win-win for both the network provider and the client/beneficiary.

I am leaving a medical group practice and wish to contract directly with NBD. What do I need to do?
Contact us and request an NBD Provider Application/Agreement packet. We’ll send the packet via e-mail (if provided), fax or via first class mail.

How do I have my top billing codes repriced in accordance with Addendum A - Participating Provider Reimbursement Amounts rate sheet?
You may email us or call us with your top billing codes (please limit to 10-15 codes). We will reprice the codes in accordance with your NBD Agreement's Addendum A rate sheet and return them to you within 3-4 business days.

Can you change the locality of the rate structure from Locality 99 (Central Valley)?
NBD is able to change the locality to match your geographic region/county if applicable (i.e. Locality 7 = Alameda/Contra Costa counties).

Where do I find the Addendum A - Provider Reimbursement Rates?
Addendum A reimbursement rate sheet is located on the very last page of the Participating Provider Agreement following the Agreement's signature page.. There is also a separate CPPA to complete, CPPA Addendum A for Medical Groups/IPAs to complete and CPPA Addendum B for reporting any professional liability actions (malpractice cases) against the provider(s).