Forum - Questions & Answers

Jun 4th, 2014 - afzal.zee 19 

Claims Credentialing issue with UBH

Can we bill under group practice name to united behavior health for a provider who is non-par to process claim in network (group is participating)? Thank you for your help.

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Jun 5th, 2014 - afzal.zee 19 

re: Claims Credentialing issue with UBH

Any help please.

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Jun 5th, 2014 - LBAROGIANIS 250 

re: Claims Credentialing issue with UBH

You can try billing the non par provider but most likely will process out of network, hopefully the patient has out of network benefits. If not, patient will be responsible for the whole bill.

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Jun 5th, 2014 - afzal.zee 19 

re: Claims Credentialing issue with UBH

We want to process these claim in network. Is it right or not if we bill claims under supervising provider?

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Jun 5th, 2014 - shanbull 51 

re: Claims Credentialing issue with UBH

[We want to process these claim in network. Is it right or not if we bill claims under supervising provider?]

Only if incident-to requirements were met, so the physician you want to bill under needs to have personally performed an initial service or consults regularly with the rendering physician about the patient's care. Here is the Medicare info sheet about incident-to requirements:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0441.pdf

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Jun 5th, 2014 - afzal.zee 19 

re: Claims Credentialing issue with UBH

I am unable to view this document, can you please send me a proper link again.

Our primary Dr. is a psychiatrist to do initial psychiatric evaluation and further medication management. We have two PhD psychotherapist and a MSW psychotherapist those are working under the supervision of psychiatrist.

Is it right or not if we bill claims under supervising provider (psychiatrist)?

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Jun 6th, 2014 - shanbull 51 

re: Claims Credentialing issue with UBH

Yes it sounds like in this situation you can go ahead and bill under the supervising provider since he is involved in evaluation and ongoing care. We do the same thing.

I will try to post the link here again but Codapedia might be blocking the full URL. If it doesn't work again just google "MLN Matters SE0441" and you should be able to access the document that way.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0441.pdf#sthash.zfd0h6l6.dpuf

The one other thing I should mention is that some insurers require a modifier on psychotherapy codes billed under the supervising provider to indicate the degree level of the person who actually performed the service. So for bachelor's degree level we use modifier HN, for master's degree we use HO, for doctorate level it's HP (unless billing Medicare in which case it's AH). If the psychiatrist himself performs the service the modifier to use is AF.

Medicare will only accept modifier AH or AF from us regardless of who performed the service, I have contacted our MAC to find out if there is any other way to do this as it doesn't make much sense and they said to keep doing it this way. Your question was about UBH anyway, but if you bill for Medicare patients ever, just remember the rules are slightly different and check the LCD's for your MAC.

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Sep 29th, 2014 - billings123 74 

re: Claims Credentialing issue with UBH

I have never used any modifiers when billing under the group for services rendered by our Clinical Psycholgist. So to my understanding, use modifier "AH" to bill Medicare when the services were rendered by the Clinical Psychologist and Non Medicare are the other mentioned modifiers? When is it appropriate to use these modifiers?

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