Medical Billing Forum
Billing => Billing => : barb2512 January 29, 2016, 04:15:44 PM
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Hello-
I am a mental health billing business with my first NC customer. She has a question I can not answer. She has hired counselors with Associate licenses.
And she wants to bill the visits to insurance. She is not sure if her NPI should go on the hcfa in 24j or if the NPI of the Associate should go there.
I am not familiar with the Associate licensing in NC. I believe it is similar to an intern in other states. In which case I would think that the answer could be different for each insurance company.
Any help is appreciated.
Barbara
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I would definitely check with that state's requirements. Specifically, I would also look at state's supervision laws. Someone can correct me if I am wrong on the following, if the provider has a NPI, that means they are licensed. Generally, the counselor is required to have a Masters degree. At least this is what I have found when credentialling with insurance companies.
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if the provider has a NPI, that means they are licensed. Generally, the counselor is required to have a Masters degree. At least this is what I have found when credentialling with insurance companies.
Having an NPI does not necessarily mean that they are licensed. However, you are correct that different insurance carriers have different policies on what license/degree/certificate is required for them to credential. If the insurance carrier credentials the type of counselor then their NPI should be in box 24J. Also, like rdmoore2003 said, check your state's requirements! That is important.
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Here is the response I received from the LPC board of North Carolina-
It would be fraudulent to attach anyone else's NPI number to a claim that another counselor conducted. LPCAs (Associates) may be able to get on panels with BCBS of NC but they have to be credentialed and approved under their own NPI numbers, education and credentials. Many areas of NC are saturated with counselors and it is sometimes difficult to get paneled as an LPCA. The LPCA has the best chance of becoming paneled if they are in a rural area or they have a specialty. The process of becoming credentialed can take 2 to 4 months to complete.
Hope this helps.
John A. Shuford
Executive Director
LPCANC
P.O. Box 266
Knightdale, NC 27545
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here is the results of my research-
I contacted the LPC board in NC and received this response in the email below- it reminds us that the counselors, any counselor seeing a client, needs to be registered with the insurance company. Now if they are registered but not contracted they are an out of network provider (regardless of you contract status).
So for each of the insurance companies that the associate is wanting to send claims to you need to contact the insurance company about the process of the associate becoming either credentialed to become an in network provider or be registered with the insurance company so the out of network claims will be recognized and processed.
Contracting, if the panels are open, can take 4 to 6 months. Registering as an out of network provider can take 30 to 45 days.
Now the second thought is finding out if the insurance company itself, in this case BCBS and UBH, are allowing associates to see client's. I have called BCBS of NC and UBH for NC and they have not yet returned my calls.
I checked on the Optum/UBH website and they are not accepting new providers in your county. The roster is full. So the associates will have to file as out of network providers. I called Network Management and they have added Tina Tuttle to the system. So she is set to send claims now to UBH/Optum.
BCBS of NC website says it does accept applications for LPCA. Which is good. However, it does not say whether or not the panel is open now or if the area is saturated and not accepting new providers. It invites providers to apply without any indication that the application will be accepted as an in network provider.
HOWEVER, it does specifically say that -Claim payments are only made directly to you if you have an active BCBSNC contract. Meaning, perhaps, that out of network claims will pay the client and not the provider.
Associates will need to be on the CAQH website. I assume you are also registered on that website so you know what I am talking about. So that is the first question, is Tina on CAQH?
The BCBS of NC website page for getting started on the credentialing process is here-
http://www.bcbsnc.com/content/providers/application/instructions.htm
As you add insurance companies to the associates for billing I will check on those insurance companies separately.
And benefits and filing are not a guarantee of payment. Claims are not guaranteed until the are processed. So just because UBH/Optum added Tina it may be the individuals insurance plan that dictates whether the claim is payable under that type of provider. And it may be that BCBS of NC will send claims payments for out of network providers to the patient.
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It would be fraudulent to attach anyone else's NPI number to a claim that another counselor conducted.
I don't know about Mental Health billing, so this comment may not be applicable in this situation.
For Nurse Practitioners and Physician Assistants who have been licensed and have NPI Numbers, they can choose to bill under their own name (get less than what physician would be paid) for supervised work they do or bill under the name of the physician for whom they work (get 100% of what physician is paid). We've had a few clients in this situation where the NPs and PAs opted to not bill under their own names. Only the supervising physician's NPI Numbers were included on the CMS 1500 form - even though they didn't do the work.
Might be useful to check out what the Mental Health billing rules say about this for the mental health employees in this instance.
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