REMINDER – Billing for Non-Physician Practitioners
| Date: | June 15, 2016 |
| To: | Health Plan of San Joaquin (HPSJ) PCPs, Providers and Practice Billing Managers |
| From: | Provider Services Department |
| Subject: | REMINDER – Billing for Non-Physician Practitioners |
| Business: | Medi-Cal, AIM (now known as Medi-Cal Access Program) |
To decrease the amount of claim denials to providers and incoming disputes to HPSJ, the following guidance is offered on the proper billing requirements for non-physician practitioners.
Per Medi-Cal Billing Guidelines:
Reimbursement for services rendered by a nurse practitioner (NP) or Physician Assistant (PA) can be made only to the employing physician, organized outpatient clinic or hospital outpatient department. No separate reimbursement is made for physician supervision of an NP/PA.
- The supervising physician’s provider number must be entered as the
rendering physician’s on each applicable claim line. - Do not identify the NP/PA as the rendering provider on the claim line.
- In the Remarks field (Box 19) of the HCFA 1500 form:
- Include the NP/PA name
- Provider number and type of credential
Medi-Cal Reference – Billing and Reimbursement:
- Online go to http://www.medi-cal.ca.gov/
- Enter this text in the Search Box (upper right corner):
https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/nonph_m00o03o11.doc
If you have any further questions, please contact our Provider Services Department at (209) 942-6340.