Author Topic: Unlicensed Clinicians billing under a supervisor  (Read 3261 times)

Brookeyz

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Unlicensed Clinicians billing under a supervisor
« on: April 13, 2018, 03:58:35 PM »
I work for an EHR for Mental Health provides. There is a lot of confusion in the organization that I work for about NPI's. So I have a few questions.

1. Do you need to be licensed to get an NPI

2. If you are unlicensed, can you bill under the supervisors NPI? If so, where does that info go on the claim?

3. If you are licensed, and billing electronically, you must have your own individual NPI correct? even if you are billing with a group NPI in box 33b?

Thanks!!!!

Michele

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Re: Unlicensed Clinicians billing under a supervisor
« Reply #1 on: April 16, 2018, 01:07:23 PM »
I work for an EHR for Mental Health provides. There is a lot of confusion in the organization that I work for about NPI's. So I have a few questions.

1. Do you need to be licensed to get an NPI

Not all specialties require a license to obtain an NPI.  However some do.  You didn't mention what types of providers these are (other than mental health).  Are they LPCs, LCSWs, PhDs?

2. If you are unlicensed, can you bill under the supervisors NPI? If so, where does that info go on the claim?

This is not in my scope.  However, I believe that while a provider is still working towards getting their license their services are billed under the supervising provider's NPI.


3. If you are licensed, and billing electronically, you must have your own individual NPI correct? even if you are billing with a group NPI in box 33b?

Thanks!!!!

There must be a rendering provider (individual) NPI showing who performed the services even when billing under a group NPI.


Hope that helps!

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Jmojica

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Re: Unlicensed Clinicians billing under a supervisor
« Reply #2 on: November 26, 2018, 03:11:46 PM »
Hi,

I work for a mental health children's facility. I mandate all providers, licensed and unlicesned to get an NPI number. Yes unlicensed individuals can get an NPI number. The NPI number is required on the billing forms under the rendering provider. Now since my company is a facility, they operate under OMH regulations which allow for unlicesned individuals to operate under a licensed supervising provider. 

However, when researching this same scenario for my private practice ( I also have my own billing business), a lot of the private insurance companies do not allow that same scenerio unless that supervising provider was also in the room for more than half of the session. So I'd advise you to ask the insurance company what their policy is before billing in that manner.

Hope this helps.