Wiki Provider by on all claims as the billing provider

[ohhernandez]

We are bringing up a practice that is currently billing with one provider for all services for all locations.

They stated that they do this because the servicing provider is not credentialed with the payor. Can they do that?

All documentation is based on the servicing provider however all claims reflect this one provider as the billing provider

 

[mitchellde]

Of course they cannot do this. The NPI in field 24 J needs to be the NPI of the provider that rendered the service, or in the case of incident to was the provider on site supervising. You can never bill one MD using a different MD NPI in field 24J. You did not specify if the providers were MD or NP or PA. If they are NP or PA then as long as you have met the incident-to rules it would be acceptable to use the MD NPI, but one of the critical points is that the provider must be in the immediate office suite area at the time of the service.

 

[ohhernandez]

Deborah,

Thank you for response.

Olga