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vickytia13

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I am billing for a pediatrics office, in the last 3 weeks I have received denials and takebacks from NHP from the last year or so. We had a PA in our office that was assisting the doctor with the overflow of patients. She was doing well visits along with sick visits. Per NHP our PA was working under the doctor but I have received all denials and take backs from all the well visits she has done. From my knowledge I know that PCP has to be assigned to that particular provider who is seeing the patient, but the claims were paid and now NHp has taken them back. I called over and the person I spoke to said I would have to let each of the patients who was seen by her to call and change the PCP assignment. I already have a hard time having them change to the doctor. Would I be able to appeal all these claims?
 
Our organization is able to change the PCP on the NHP website. I am in Massachusetts, I don't know if the RI product is different. We have to get the patient's permission but we are able to make the change ourselves now. This went into effect a few years ago. Can you reach out to your NHP rep?


Heather
 
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