99243 by CRNP in Hematology/Oncology Practice

bgeiser

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My first visit to a hematology/oncology practice was with a CRNP. I have no problem with this; she was very nice and well informed - I did not see a physician.

When the claim was billed to my insurance company (99243), the billing provider listed was the group practice & the rendering provider was listed as the physician for whom the CRNP works.

The claim was paid as if I had been seen by physician - there is no mention of the CRNP on the claim.

Since the CRNP is an employee of the group practice, is licensed, has an NPI, and according to the medical policy of the insurance company is considered an Eligible Professional Provider, why would she not be the rendering provider?

Thanks,
Bethann
 
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Was this truly a consultation? Did you get referred there by a provider within the same group (as in, same TIN)?
 
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