Physician assistants required to re-enroll earlier this year

Physician assistants were required to re-enroll with Blue Cross Blue Shield of Michigan and Blue Care Network so they could be reimbursed for services within their scope of license for services that occurred on or after Feb. 1, 2018. Re-enrollment began Oct. 1, 2017 and required physician assistants to:

• Re-enroll and be credentialed with Blue Cross and BCN, including our Medicare Advantage programs.
• Complete our attestation form, indicating that they have a legally required practice agreement with a physician, along with other required documents.
• Enroll as part of an existing contracted group or request participation via a new group practice (for BCN).
• Complete a CAQH ProView credentialing application within 14 calendar days of submitting enrollment requests.

Previous reimbursement arrangements were terminated for dates of service after Jan. 31, 2018.

For services that occur on or after Feb. 1:

• PAs who re-enrolled by Jan. 31 will be eligible for reimbursement for services within their scope of license either directly or under a group for all lines of business. PAs who have not will have their claims denied.
• PAs may choose to continue to be affiliated with physician groups and bill under the groups. If so, PAs should ensure they indicate the group information when they contract and re-enroll.
• PAs will continue to be reimbursed at 85 percent of the physician fee schedule.
• BCN authorization and referral requirements did not change and will continue to apply.
• If billing indirect/incident to, please make sure you are following this criteria:
• The physician delivered any component of the service.
• The physician provided specific clinical direction or consultation on an individual case basis to the PA prior to or during the service billed on that specific date.
• The PA presented pertinent clinical findings and obtained approval of evaluation and management by the physician prior to the end of the day following the service. (Specific clinical direction does not include the application of general protocols or care pathways.)

For more information, see your provider manual on web-DENIS.