PA'S

[ellie]

  WE HAVE A PHYSICIAN AND PA. THE PA SEE'S PATIENT'S ALSO. PHYSICIAN IS IN NETWORK WITH BC, THE PA WORKS ALSO IN OUR OFFICE AND SEE'S PATIENTS. BC DENIED CLAIM STATING PA IS NOT IN NETWORK.

DO THEY NOT USE THE PHYSICIANS BC PROVIDER ID - THEY USED THE PA'S NPI STATING THATS HOW THE CLAIM CAME TO THEM.

LET ME KNOW WHAT TO DO.

[troyrands]

you can add your PA as a rendering dr and the PHYSICIAN name must be tagged under a refering doctor. Then BC will pay for the procedure. we got paid for our family and dermatology practices.

[PMRNC]

Still have to go through the credentialing process with carrier, provider has to add them and get them credentialed. Not all carriers will credential the PA

[ellie]

Could this have been a recredentialing problem- the PA has since left the office for another position. what to do ?

[ellie]

Or as the prior above answer - Put PA as rendering and primary doctor as referring - not quite understanding.

[Michele]

If the PA saw the patient then they are the rendering.  If they are not in network with BC then putting the MD as referring won't make a difference.  Unfortunately since they are no longer at the practice things are just more complicated.  If the PA rendered the service and they weren't credentialed individually with BC (even as part of the group) there is not much you can do about it now. 

[ellie]

Thanks Michelle, I figured so.... The patient's OOP is more they are wondering why.

[PMRNC]

All isn't completely lost yet.. have the patient contact the insurance company and explain that they believed the practice to be in network but saw the PA who was not in network.  MANY times the carrier will pay the charges, be sure to tell them that the PA is no longer in the office so it would be a one/time thing.  Not promising but claims examiners are given payment authorization threshold's for administrative claim decisions like this.

[LASHUNDA]

I'm in Texas and below is what BCBSTX told me about billing for NP's and PA's.  I've also seen this posted to other Blues plans as well.  Because the Blue plans has Blue Card set up to bill claims as primary to your local BCBS plan for most Blues plans you will need to follow the directions of the Blues plan is in your state.   You can also bill a PA and NP services as "incident to".  Access the website for your local BCBS plan.

Since they are out of network, to bill you would use the MD/ DO's rendering NPI # as the performing  with the appropriate modifier "SA" or "AS" on the claim.   

Thanks,
La Shunda