Billing > Billing

Billing under a different NPI

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Michele:
It would have to be billed under the provider that physically saw the patient.

Pick3dlast:
So in the most recent example you gave, if a Locum saw the patient than it would strictly be under his name and NPI with groups TIN & the modifier indicating locum tenan. If a patient was seen by a provider that was part of a contracted group all he would have to do is get credentialed to see patients. Contracts are group specific only. If the group was contracted and he was not credentialed then your claim will deny for non-contracted. unless you had a letter of agreement on file through that particular Health plan (very rare because they are patient specific) The renderings NPI must always be the one in box 24J of a CMS, the only exception to this is a mid-level can be paid under the resident or practice owner (if physician).

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