Reminder: Mid-level practitioners NPI reporting requirements

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

 

Anthem provides benefits for covered services rendered by nurse practitioners (NPs) and physician assistants (PAs) when operating within the scope of their license.

 

Physician assistants:

• The Indiana Health Coverage Program (IHCP) requires all services rendered by a PA to be submitted with the PA’s individual NPI.
• Whether the member is assigned to the PA or the PA is acting as a specialist, claims may not be submitted using the individual NPI of the supervising or other physician.

 

Advance registered nurse practitioners (APRNs):

• IHCP requires all services rendered by an APRN to an assigned member to be submitted using the individual NPI of the APRN.
• Services furnished to members that are not assigned to the APRN’s panel may be submitted using the APRN’s individual NPI or the individual NPI of the supervising physician, if they are employed by a physician-directed group or clinic.
• All claims submitted by a certified registered nurse anesthetist (CRNA) must be submitted with the CRNA’s individual NPI and must include the applicable medical direction modifier.

 

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 Provider Services:

• Hoosier Healthwise: 1-866-408-6132
• Healthy Indiana Plan: 1-844-533-1995
• Hoosier Care Connect: 1-844-284-1798
• Medicare Advantage: Call the number on the back of the member ID card.

 

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