Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Indiana Medicaid MCEs also Fully Enrolling All PAs, Reimbursing at 75%

enrolling PAs

Beginning September 1, 2018, all physician assistants (PAs) must now enroll both with Indiana Medicaid and all Indiana Medicaid Managed Care Entities and can no longer be billed under a supervising physician’s NPI.

This change, which we previously reported as affecting Indiana Medicaid only, brings billing for PAs into alignment with billing for other Mid-Level, or Non-Physician Providers (NPP), and reduces reimbursement for PA services to 75 percent of the Medicaid allowed amount for dates of service on or after September 1, 2018.

Since our earlier articles, Denise O’Brien, CIPROMS Director of Provider Enrollment, has confirmed with all of IHCP’s managed care entities (MCEs) that after enrolling as a provider with Indiana Medicaid, PAs must apply directly with each MCE to participate as a provider in all of IHCP’s managed care programs―Healthy Indiana Plan (HIP), Hoosier Healthwise, or Hoosier Care Connect.

As we noted earlier, when both the physician and the PA provide any face-to-face portion of an evaluation and management (E/M) encounter, the service may continue to be billed under the physician’s NPI based on split/shared visit rules. (Refer to page 39 of the Medicare Claims Processing Manual: Chapter 12 – Physicians/Nonphysician Practitioners for more information on split/shared visits.)

For more information about how the new policy will affect PA enrollment and billing with Indiana Medicaid, review the following:

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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