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Billing PA to a Payer that Doesn't Contract PA's

Tierni Posted Mon 25th of January, 2016 15:53:58 PM

We have a PA that assisted one of our MD's in a surgery. When billing Cigna, we listed the PA and the appropriate modifiers to indicate the PA was the assist. Cigna denied the claim; stating they do not contract PA's. We are now receiving internal guidance to bill the claim under the MD. However, if we did that, then it would look like the MD assisted themselves.

The payer is going to reprocess the claim as out of network, but I really do not want the patient to receive a bill. Can you please provide another suggestion?

SuperCoder Answered Thu 28th of January, 2016 09:52:17 AM

As per Cigna, they do not contract PA's.
Hence, proceed as per your internal guidance to bill claim for MD.

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