Wiki PA claims submitted as Billing provider and Rendering provider for group

[tworrock]

Hello,

We recently added a new physician assistant to our group. Our EHR was not set up correctly and has been submitting electronic claims with her NPI as billing provider AND her NPI as rendering provider. Check remittance has been received with her name on the check. It should have been submitted with her NPI for the rendering provider and our group NPI for the billing provider. Do I need to resubmit all of these as corrected claims if they have already been paid?

Thank you!

 

[thomas7331]

If the claims were submitted and paid with the correct tax ID number, and were paid correctly per the group's contract, then there shouldn't be a need to resubmit these. But if they were paid to her SSN instead of to the group's tax ID, then that could be a problem because the payers will be reporting that income to the government as her personal income instead of the group's income.

 

[tworrock]

If the claims were submitted and paid with the correct tax ID number, and were paid correctly per the group's contract, then there shouldn't be a need to resubmit these. But if they were paid to her SSN instead of to the group's tax ID, then that could be a problem because the payers will be reporting that income to the government as her personal income instead of the group's income.

Thank you! That is very helpful. We don't have the provider's SSN in our EHR I don't think... and I know we have submitted them with our tax id, so I guess we are good. All of the provider's Medicaid and Medicare claims got kicked back as the billing provider was not eligible for electronic submission, which led us down this path to figure out how we needed to enroll her in electronic submission... then to find out from Availity support that since we bill as a group, she did not have to individually enroll and it was actually that we had submitted her as billing NPI and rendering provider NPI and that's why Medicaid and Medicare kicked it back.

So long story short, we got our EHR support to update her to bill under our group and we rebilled her Medicaid and Medicare claims with it reflecting our group for billing NPI and her NPI for rendering provider. I hope that makes sense?