AS modifier out of network payer
I work in a neurosurgery office in Texas. We have 2 mid-levels who are employees of the surgeons & assist in surgeries as well as seen patients in the office.
Some of our contracts are with an IPA that does not credential mid-levels. Because we are a delegated group, we cannot go outside the IPA to contract with the few insurances that we have with them to get in-network status for our mid-levels.
I am being told (by the IPA) that when billing for mid-level surgical services to out of network payers, we should append the AS modifier to the charges with the rendering provider NPI being that of the surgeon, because the mid-level would not be in the payers system.
For our in-network surgical claims, we use the AS modifier & the mid-level rendering NPI.
Can someone please give me clarification on this? Any additional documentation you could provide, would be greatly appreciated!!!
Thanks in advance!
Tammy
I work in a neurosurgery office in Texas. We have 2 mid-levels who are employees of the surgeons & assist in surgeries as well as seen patients in the office.
Some of our contracts are with an IPA that does not credential mid-levels. Because we are a delegated group, we cannot go outside the IPA to contract with the few insurances that we have with them to get in-network status for our mid-levels.
I am being told (by the IPA) that when billing for mid-level surgical services to out of network payers, we should append the AS modifier to the charges with the rendering provider NPI being that of the surgeon, because the mid-level would not be in the payers system.
For our in-network surgical claims, we use the AS modifier & the mid-level rendering NPI.
Can someone please give me clarification on this? Any additional documentation you could provide, would be greatly appreciated!!!
Thanks in advance!
Tammy
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