Incident to Billing Policy
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Governs billing practices for incident-to services for providers submitting claims to Blue Cross and Blue Shield of Montana (BCBSMT), excluding Medicare lines of business; applies to providers submitting claims under their own NPI.
Clarified language regarding physicians submitting claims for services performed by non-physicians.
Coverage Criteria
Coverage stance
BCBSMT stance on incident-to billing and claim submission requirements:
ALL of the following
Policy position
- BCBSMT does not recognize incident-to billing and requires that claims be billed under the provider who actually rendered the service.
NPI and claim submission
- Providers must submit claims under the NPI number assigned to them; submitting claims under another provider's NPI is prohibited and may be considered fraud under Montana law (Montana Code Annotated 33-11-202(1)).
Exceptions
- Allowing another provider to use one’s NPI for BCBSMT claims is only permitted as described in the Locum Tenens Policy or Provider-in-Training Policy.
Physician / non-physician billing
- Physicians may not submit claims for services provided by non-physician practitioners under the physician's NPI because non-physician providers are subject to a different fee schedule; this applies regardless of supervision.
Coding and Fee Schedule Attribution
| No codes listed |
Provider Actions and Billing Requirements
Bill under the rendering provider's NPI; exceptions only for Locum Tenens or Provider-in-Training
Submit claims using the NPI of the provider who actually rendered the service; do not bill services under another provider's NPI. Providers must submit claims for services under the NPI number assigned to them; allowing another provider to use your NPI for BCBSMT claims is prohibited except as described in the Locum Tenens Policy or Provider-in-Training Policy. Physicians may not submit claims for services provided by a non-physician practitioner under the physician's NPI because non-physician providers are subject to a different fee schedule.
- Claims must be billed under the name/NPI of the provider who rendered the service.
- Submitting claims under another provider's NPI may be considered fraud under Montana Code Annotated 33-11-202(1).
- Exceptions permitting use of another provider's NPI are limited to the Locum Tenens Policy and Provider-in-Training Policy.
- Physicians may not bill services performed by non-physician practitioners under the physician's NPI due to differing fee schedules.
Definitions
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