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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Billing NP to Medi-cal CA for Palliative Care
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Post Billing NP to Medi-cal CA for Palliative Care
Author: Jennifer
Date: Oct 13, 2010 2:00 pm
I need some help and hopefully someone here can help me out. I am not sure if Medi-cal has changed some rules, but we used to bill for NP's independently for their palliative visits and get reimbursed 80% by mcal. Now we are getting denied for not an active provider. Mcal stated "

NP’s are not listed under their initial NPI’s in the Provider Master File (PMF) system. When they are enrolled they are listed under the group NPI and then their information is built under that group.
Therefore, when HP Services (Formerly EDS) checks the system and they put the NP’s NPI they are not going to come up with any information because they are not enrolled like a physician. HP would need to go under the group’s NPI , they would need to go to the screen “PROVIDER INQUIRY - DETAIL NAVIGATION KEY LIST” and look under the “NMPS” option that lists all the NP’s by their NPI and Lic # under the group.

The bottom line is that the group is active and they need to bill under their group NPI for the NP’s services. So, HP needs to assist you in how to fill out the claims to have the Medical group’s information foremost and the NP’s information secondary for billing. Since we don’t handle billing I am unable to instruct you on how to complete the claims. My suggestion is to request a supervisor and go over the information above."
This was the response from provider Enrollment.

Does anyone bill this way? Do you bill the NP under your group NPI number to Medi-cal CA? PLEASE HELP



Replies: order by [Date] [Author] [Subject]
Re:Billing NP to Medi-cal CA for Palliative Care (by JulieP on 11/01/2010)
In Wisconsin we submit the claims under the mid-level's number; what California is saying seems a little off to me. I went on the MediCal web site to do some fact gathering and I didn't find anything uselful. Because the question is specific to California we don't have an answer for you at this time. We are reaching out to providers/groups we know in CA and hope to have some useful information for you soon.
Julie Pipke-CPC, CAPC Consultant

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