I would love any help you can provide with this scenario. I bill for a Nurse Practitioner that owns her own family practice. She is credentialed with all insurances under her own tax-id. We have been billing under her own tax-id for 9 months now. Because of the way she was credentialed with Blue Cross Blue Shield, they required her to get a group NPI and she must file under that. If we file under her individual NPI, we get rejections stating that is not a billing NPI.
Now, we have a new collaborating physician who also has her own practice at a different location. She comes to our clinic a couple days a week as required by law. She too is credentialed with BCBS under her group NPI.
So now, here's where our issues begin. Because our NP cannot be a PCP on HMO plans, those claims must be filed under the MD using an SA modifier showing the NP acutally saw the patient. Because we must file BCBS claims using group NPIs, we have the clinic's name and address with it's group NPI in 32 and 32a. We then have the clinic's name and address and the MD's group NPI in 33 and 33a. We then have the MD's individual NPI in 24j. Basically the only thing on the claim that designates the NP was involved is the SA modifier and her clinic's group NPI in 32a. Can you have 2 different group NPIs on the same claim? How should we be billing this scenario?
Also, we want all of the payments to come to our clinic where the service was performed, NOT the doctor's other location. Even though we put that information in 32 and 33, checks and EOBs are going to the doctor's main office. How are insurance companies getting that address? Does the doctor need to add our clinic's address to each indivdual insurance carrier?
Thanks in advance for any help you can give!
Julie