Provider in Training Policy
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This policy governs billing, supervision, and documentation requirements for services rendered by providers in training to Blue Cross and Blue Shield of Montana (BCBSMT) enrollees, excluding Medicare Advantage. It affects preceptors (supervising licensed providers) and providers in training who are licensing candidates or doctoral students.
Revised Claims Submission, Supervision Requirements, and Documentation.
Billing, Supervision, and Documentation Criteria
Billing, supervision, and documentation criteria
Covered when ALL of the following are met:
Sanctions or denials
- If a Preceptor does not comply with applicable state law in supervising a trainee and billing under this policy, BCBSMT may deny the claim and/or refer the billing to the Preceptor's licensing board.
- If BCBSMT determines a Preceptor lacked personal knowledge of the trainee's services despite billing under the Preceptor's NPI, BCBSMT may report the billing to authorities as suspected fraud.
Claim Submission and Coding Rules
Claims Submission and Supervision Requirements — Actions for Preceptors
Claims must be submitted under the Preceptor’s individual rendering NPI
Preceptors must submit claims under their individual rendering NPI; provider-in-training information must not be included on the claim. Submission under the Preceptor's NPI certifies the Preceptor's personal knowledge that services were rendered per Montana licensing requirements, and reimbursement remains subject to member coverage and medical necessity review.
- Do not include the provider-in-training on the claim form; use the Preceptor's individual rendering NPI.
- By submitting the claim under the Preceptor's NPI, the Preceptor certifies personal knowledge that services complied with Montana licensing requirements.
- Claim payment is conditional on the member's coverage and medical necessity determination.
Key Definitions
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