Reminder: Mid-level practitioners are required to file using their NPI

This communication applies to the Medicaid, Medicare Advantage and MMP programs for Anthem Blue Cross (Anthem).

 

Anthem provides benefits for covered services rendered by nurse practitioners (NPs) and physician assistants (PAs) when operating within the scope of their license. Our policy states that these mid-level practitioners are required to file claims using their specific NPI number — not that of the medical doctor.

 

We will continue to monitor this area of concern through medical chart review and data analysis. Billing noncompliance can be considered a contract breach.

 

Anthem recognizes the quality of care delivered to our members can be improved by the proper use of NPs and PAs. This notice is in no way intended to discourage their proper use, but rather to clearly define how services should be appropriately billed.

 

Thank you for your continued participation. Should you have any questions, please call one of our Provider Customer Care Centers:

• Medi-Cal (Outside L.A. County): 1-800-407-4627
• Medi-Cal (Inside L.A. County): 1-888-285-7801
• Cal MediConnect: 1-855-817-5786
• Medicare Advantage: Call the number on the back of members’ ID cards.

 

Reminder: Mid-level practitioners are required to file using their NPI

Click here for more information about the Reimbursement Policy Update Child Health and Disability Program (CHDP).

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