GALLAST
New
Novitas Solutions, Jurisdiction JL, denies our Nurse Practitioner new patient claims if the patient has seen another nurse practitioner in the practice, New Patient Qualifications not met. After appealing with notes indicating why each nurse practitioner saw the patient, Novitas upholds the denial indicating that patient saw a nurse practitioner on another date, so patient is established within the practice and new patient qualifications were not met. Our coding team states that according to AMA guidelines, each NP saw the patient for a different specialty, therefore, new patient qualifications do apply. Novitas tells me that they follow CMS guidelines and that NPs are not credentialed as specialties. Does anyone know where I can find that information in writing?