Wiki SA modifier for Nurse Practitioner with BCBS of NJ?

[tiffany226]

Hello. I recently started a new billing position and this office has been billing claims to bcbs of nj with an SA modifier if the patient is seen by our Nurse Practitioner. This is causing patients to have a higher copay then if they were to see our drs. I spoke with the bcbs credentialing department and they said the NP is credentialed correctly as a pcp. This office has been having the patients call their insurance and fight them on copay issue and once the claims are reprocessed they are paid correctly. But it is causing a lot of phone calls and aggravation and if i could I would like to try and fix this issue but I am at a loss because the other billers insist this is how its supposed to be billed. Does anyone else bill this way? please help before I go to my manager and make a change. thank you so much

 

[csperoni]

-SA is required by some insurances per their policy on claims billed incident-to. Meaning if your PA/NP/CRNS is seeing the patient, AND it meets all incident-to requirements, the claim is billed under the physician's name. Whether or not your NP claims for BCBS of NJ should have -SA depends on 1) BCBS of NJ policy and 2) if the services meet all incident-to requirements. If your practice is incorrectly using -SA, then discuss with your manager how to correct this. If your practice is correctly using -SA, and BCBS of NJ is making this error repeatedly, try to get to a higher level of employee at BCBS of NJ who can look into the matter and make this correction moving forward. Perhaps your manager knows who your provider relations rep (many insurances don't have assigned reps anymore) or who a better contact might be rather than just the generic person who answers the 800 number.