We have a nurse practitioner who is waiting for credentialing by commercial insurance (UHC, CIGNA...), may we bill her charges under a supervising physician?
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Wiki NON-CREDENTIALED NP BILLING INCIDENT TO
- Thread starter lauren@nexusmedicalbilling.com
- Start date
SharonCollachi
Guest
You will have to ask each insurance company.
It depends on the insurance policy - whether or not the insurance follows Medicare's incident-to rules and whether or not they credential NPPs.
If they follow incident to, you may bill under the physician only if it meets the incident-to guidelines (established pt with established plan of care and the physician is onsite, etc.)
If they do not, most carriers want the NP claim billed under the NP. Some insurances do not credential NPP's and state to bill the claim under the supervising physician.
If they follow incident to, you may bill under the physician only if it meets the incident-to guidelines (established pt with established plan of care and the physician is onsite, etc.)
If they do not, most carriers want the NP claim billed under the NP. Some insurances do not credential NPP's and state to bill the claim under the supervising physician.
Also, some insurances will make the participating date the date they received the application. So the claims may initially process out of network, but can be reprocessed once your NP is approved. Others will only make the par date the date they approved.
Credentialing is definitely one of those things where every carrier makes it's own policy, and everyone is different. It's always a struggle with any new provider in the office - NPP or physician.
Credentialing is definitely one of those things where every carrier makes it's own policy, and everyone is different. It's always a struggle with any new provider in the office - NPP or physician.
Thanks for the input, much appreciated.
toria11
Guru
Billing incident-to in these cases can be risky too because the patient could bring up a new problem at the visit that needs to be addressed and then the visit would no longer be incident-to. If that's the case, the visit would be billed out of network if the APP is not credentialed yet, correct?