Wiki Dual Credentialed Physicians

[bkindelberger412@gmail.com]

How do you handle a physician that is dual credentialed when billing for them as a specialist. We have problems with health plans assigning the incorrect copay because it is not clear as to whether the physician saw the patient as a PCP or specialist. I wish there was a modifier we could use to specify the patient was seen by a provider acting as a specialist.

 

[thomas7331]

There's no modifier that I know of for this situation unless your payer has a specific policy that designates on that they want you to use. I think this is something you'll probably just have to work out with the payers though. You might consider seeing if this payer would be willing to set up the provider with two different provider numbers in the system so you can bill the provider number that is appropriate to the specialty under which the provider as acting at each encounter, or talk to your network rep to see if there are any other ways to resolve this or else expedite adjustments when this occurs.

 

[bkindelberger412@gmail.com]

Thank you, exactly what I thought I would have to work it out with the health plan. I do think though that to simplify things that there should be a modifier to distinguish what specialty is being billed for under that dual credentialed provider. I will suggest that to Humana and see what happens.