Can more than one L.Ac. submit a claim under the number of another L.Ac.?

Hi,

My boss is an L.Ac. and clinic owner and wanted to get a group number for our newly employed acupuncturists. It seems, though, that group numbers for acupuncturists aren’t happening yet, and is still only a benefit for allopaths.

So…the L.Ac. clinic owner is wondering now if those same acupuncturists to be on our payroll can submit insurance claims under the clinic owner’s own insurance provider number(s). (The clinic owner is currently a sole proprietorship.)

I’m trying to do my due diligence elsewhere and am waiting on the acupuncture board to get back to me as I type this. My boss does not use a billing service for me to ask, though I did try. I’m about to embark into the black hole of an insurance company’s phone tree to ask them.

At any rate, I figured this might be a good place to toss the question out there, too. Anything to help fill in blanks.

Thanks for any assistance. I appreciate that you are here and look forward to using you as a continued resource.

Thanks for your question and I will try to give some advice but I can’t give a yes or no answer. First off, insurance is regulated in a state by state manner so there can be different regulations involving what can and can’t be done in different states. Second, I believe when you mention the clinic owner’s own “insurance provider number” you are probably referring to being an in-network or even contracted provider of a specific health insurance plans or plans. In that case, it is up to the insurance plan’s policies whether or not they allow services performed by an employee acupuncturist to be billed under the employer’s provider number. I work with American Specialty Health (ASH) and their policy is that bills submited for providing a service to an ASH covered patient can only be for services done by a credentialed (approved) ASH provider. Other companies may have different policies regarding this but you would need to find that out from them.  If you are referring to simply billing insurance not as a preferred or contracted provider, that would be up to the state to decide if the provider information given on the billing could be for anyone other than the one who actually provided the service such as an employer’s information for an employee’s service.

I hope that helps and please let me know if I covered what you were asking and anything more you may learn about this. The whole idea of my Forum here is to share information with others so we can all learn and benefit. Best  –  Matthew Bauer

Fantastic – this definitely helps and reflects what I learned from Acucare (of California) who handles acupuncturist contracting for several insurance companies.

The Acucare rep did also suggest/confirm that payment could be possible to the clinic owner by way of the clinic owner’s EIN on the HCFA, along with the address provided in Box 33. I will definitely heed your words that the best information will be obtained by each insurance individual insurance company (the Acucare rep probably said as much, too). 

You are correct that I was referring to an in-network provider number and I will definitely keep you posted with any new update.

On a tangent note, it was interesting in my online research today to come upon mention of the illegality of fee-splitting (say, from clinic lessees?) and kickbacks (for direct referrals)… Fortunately, the boss was not looking at doing any of that.

Thanks again!

Matthew Bauer

You can get a group/practice NPI that is seperate from the NPI numbers issued to individuals if you are going to bill as a practice.

www.yoursourceforwellness.org

Matthew Bauer