UHC Community Plan of NJ - billing of NPs, PAs, or other mid levels?

[ajvanekeren]

How is everyone getting reimbursed by UHC Community Plan of New Jersey for nurse practiioner or physician assisant claims? For context, we are OBAT substance abuse via telehealth. We bill e/ms with telehealth modifiers. I tried GT and 95 modifiers on the claims per UHC telehealth modifier policy but neither worked. I then read their policy regarding SA modifier, but it's still unclear to me. Our NPs and PAs do have collaboration agreements with an MD. If we don't use SA modifier, we get a denial with CARC 256. I tested 10 claims with SA, 95 modifiers, and this worked. I didn't bill under an MD and nothing was listed under supervising. This seems wrong to me.

If anyone is getting their mid level telehealth claims reimbursed by UHC NJ Medicaid plans, let me know. Thanks!