Blue Cross PA Credentialing Deadline – October 1st
Blue Cross Blue Shield sent the following memo to BCBS Providers. Please contact your credentialing office or billing office and ensure you are enrolled!
Physician Assistant (PA) contracting required by October 1, 2014
Date Issued: May 12, 2014 Effective Date: Oct 1, 2014
To: The hospitals, physicians, urgent care centers, and community health centers that employ or reimburse PAs, and the PAs who provide care to our members
From: Stephan Katinas, Vice President, Network Contracting In response to Massachusetts’ Health Care Cost Containment law, Blue Cross Blue Shield of Massachusetts (BCBSMA*) will credential and contract with all physician assistants (PAs) who bill for services on a CMS-1500 paper claim or 837P electronic claim.
What this means for you and your practice For dates of service starting October 1, 2014:
* All PAs who provide professional services and whose services are billed on a paper(CMS-1500) or electronic (837P) claim form must apply to credential and contract with BCBSMA.
* We will enroll credentialed and contracted PAs in our HMO, PPO, Medicare Advantage, and Indemnity products.
* The PA’s supervising physician must be a BCBSMA credentialed and contracted provider.
* You may not bill for professional services provided by non-contracted PAs after October 1, 2014. To allow sufficient time for the credentialing and contracting process, please submit applications as soon as possible.
* We will not contract with independently practicing PAs in bordering states.
Must designate whether PA provides primary care or specialty care services As part of the contracting process, the PA must designate whether he or she will provide primary care services or specialty care services. This designation will indicate how the PA is listed on our Find-a-Doctor online directory.
Note: PA – primary care means a PA who renders primary care but DOES NOT maintain a panel of patients. A PA – primary care is not a PA-PCP. For information about contracting as a PA-PCP, please refer to our F. Y./. dated July 1, 2013.) Reimbursement will be at:
* 85% of the MD fee schedule
* 100% of MD fee schedule for drugs, vaccines, and clinical laboratory services
* Only bill for codes on the PA fee schedule.
* Use the PA’s NPI and the AS modifier when billing for assist at surgery services.
Bill this way when the PA renders care under direct supervision of the physician. This means that the physician must:
* Be on-site when the care is rendered by the PA; * Be actively involved in the decision-making process of the patient’s care; * Provide documentation/attestation of the collaboration in the medical record by signing and dating the patient’s chart on the date that the service is rendered.
You cannot bill under the MD’s NPI for the PA’s assist-at-surgery.
The MD’s NPI with the AM modifier 100% of the physician fee schedule If billing
The PA’s NPI Billing for PA services For dates of service on or after October 1, 2014, you can bill for services provided by contracted PAs in two ways.
How to Become a BCBSMA PA To apply to become a participating BCBSMA PA, please follow these steps; see the Resources section below to learn how to access the documents.
1. Review the BCBSMA Professional Credentialing and Re-credentialing Requirements.
2. Complete the Physician Assistant Contracting Application online, then print and fax to us.
Ensure that the PA can meet the credentialing requirements.
Apply to become a PA.
We will carefully review the information to ensure that the applicant meets our PA network requirements, and send the applicant an Agreement to sign. The effective date of the PA Agreement will be the date BCBSMA executes the Agreement; this will be the date shown on the welcome letter.