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How should claims be filed when a PCP refers a CA Enrollee to our office?

April 26, 2017ca enrollee filed Office pcp

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How should claims be filed when a PCP refers a CA Enrollee to our office?

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When a PCP refers a CA enrollee to your office, you should be given the PCP’s NPI authorization number. When filing your claim, you must put the referring PCP’s NPI authorization number in block 17b of the CMS-1500 claim form. Clarify with the PCP what time or treatment limitations are placed on the authorization; e.g., good for the full course of treatment, good for one visit, etc. Since CA enrollees can change PCPs monthly, you must check the card each month to verify the PCP.