Wiki Urgent Care billing with POS 11

[Woakes73]

I have a provider who's NPI is listed as Urgent care and he keeps billing as POS 11. I've been denying these claims for correct POS.
The provider has now come back saying his claims can be paid with POS 11 because they are Covid test's/ screening claims.
I'm not able to find that information any where.
Would anyone have any help with this?

 

[thomas7331]

I think this is going to depend on how the urgent care center credentialed. Is it wholly owned by the provider and operated under the provider's own tax ID, or is it set up as an independent facility in which the provider is simply performing professional services? The language of the provider's contract with a particular payer may also specify what place of service code should be used, based on how the facility is enrolled with that payer. I don't think you're going to find a 'yes or no' answer here - this will all depend on the nature of the urgent care center and their relationship with their payer.

 

[Woakes73]

I think this is going to depend on how the urgent care center credentialed. Is it wholly owned by the provider and operated under the provider's own tax ID, or is it set up as an independent facility in which the provider is simply performing professional services? The language of the provider's contract with a particular payer may also specify what place of service code should be used, based on how the facility is enrolled with that payer. I don't think you're going to find a 'yes or no' answer here - this will all depend on the nature of the urgent care center and their relationship with their payer.

That's what I was also thinking. I had reached out to the insurance company to see what their contract says. Thank you for your input.