SCENARIO 1: The psychiatrist performs the initial psychiatric evaluation of the patient and develops a plan of care that includes medication management and psychotherapy. In addition to the changes incorporated into the APHC policy, UHC has also now created a separate Services Incident-to a Supervising Health Care Provider Policy, Professional policy, which outlines the requirements and criteria for reporting the service provided as incident-to a supervising health care provider by an APHC provider or nonphysician provider including billing under the supervising physicians NPI number and required usage of the SA modifier. Claims, Explanation of Benefits | Cigna Cigna - Mastering Insurance for Mental Health Professionals Likewise, state Medicaid programs and managed Medicare and managed Medicaid plans may set their own rules. Treating providers are solely responsible for medical advice and treatment of members. Historic gains in health information exchange and the rise of consumerism are driving health technologys evolving. Medicare allows for the billing of incident to services performed by ancillary personnel under the supervision of a qualified Medicare provider. ClaimsXten Clear Claim ConnectionTM, Cigna's code edit disclosure tool powered by McKesson, allows users to enter CPT and HCPCS coding scenarios and to immediately view the audit result. To view all forums, post or create a new thread, you must be an AAPC Member. Editors note In brief, services that would normally be part of the treatment of a patient by a physician are rendered by an auxiliary person, functioning under the direct on-premise supervision of a physician. Once approved, we pay the health care provider or reimburse you, depending on who submitted the claim. <> The original policy change for UHC commercial products was effective March 1, 2021, and for exchange products was effective on May 1, 2021. WebPlease verify that your contract includes the applicable Revenue and Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) codes prior to billing since they may impact authorization requirements. Coverage and Claims | Cigna Nurse practitioners are licensed by the state in which they practice. CMS has not specifically defined the word immediate in terms of time or distance; however, an example of a lack of immediate availability would be situations where the supervisory physician is performing another procedure or service that he or she could not interrupt.. A specific list of Cigna combinations that require documentation is available on the Cigna for Health Care Professionals website atCignaforHCP.com.
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