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Reminder: Nonphysician Practitioner E/M Claims - Change in Submission Instructions Effective 9/15/2018

NGS is reminding all entities submitting E/M claims on behalf of NPs (NP-Specialty 50) and PAs (PA -Specialty 97) of a change that was implemented on 9/15/2018.

Information on these claims should now include the specialty of the physician group in which the service was performed by the NP or PA. This information should be included in the 2400 Loop NTE Segment (or Box 19 on paper claims).

When more than one E/M service by an NP or PA is billed on the same date of service, this information will allow NGS to compare the specialty and diagnosis information on the two claims;  when that information differs, payment may be allowed on the second claim.

We realize that this change may entail coordination with electronic billing software and billing vendors; we encourage providers to expedite implementation in order to avoid unnecessary denials and appeals for these services.

Posted 9/13/2018
Revised 10/17/2018

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Last Modified: 10/17/18
Reminder: Nonphysician Practitioner E/M Claims - Change in Submission Instructions Effective 9/15/2018
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