Reminder: mid-level practitioners are required to file using their NPI
We provide 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 may be considered a contract breach.
We recognize the quality of care delivered to our members can be improved by the proper use of NPs and PAs. This notice is not 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 the Provider Services number located on the back of the member’s card.
March 2020 Anthem Connecticut Provider News