Nurse Practitioner Primary Care Program Billing Basics
Learn the essentials of billing for the Nurse Practitioner Primary Care Program in Alberta Health, covering topics such as practitioner and facility identification, business arrangements, and health service codes. Explore the requirements for submitting claims, referrals, and payment in this informative guide.
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Presentation Transcript
Nurse Practitioner Primary Care Program Billing Basics Alberta Health July 18th, 2024 Classification: Protected A
Topics Practitioner ID Facility ID Business Arrangement Service Codes and Claims Submission Reporting & Reconciliation 2 Classification: Protected A
Practitioner Identifier An identifying number assigned to each practitioner registered with the Alberta Health. Required for submitting claims, referrals and payment A PRAC ID is nine numeric characters long, with a four-digit set and a five-digit set separated by a dash (e.g., 1234 56789). 3 Classification: Protected A
Facility Identifier Registration Each facility is assigned a unique ID. Identifies the physical location where health services are provided Only for locations for in-person patient care. Cannot be transferred, any changes must be reported to Alberta Health New clinics must register for Facility ID with Alberta Health 4 Classification: Protected A
Business Arrangement Establish arrangement for payment of health services and identifies: WHO is to be paid WHERE statements are sent WHICH submitter is authorized to submit claims for that business arrangement. Skill code must be identified for Nurse Practitioners NRPR Must be attached to accredited submitter Must be on all claims submission Corporations are required to have a Business Arrangement Only contract holder can make changes to Business Arrangement 5 Classification: Protected A
Business Arrangement - Form 6 Classification: Protected A
Business Arrangement - Form 7 Classification: Protected A
Business Arrangement - Form 8 Classification: Protected A
Nurse Practitioner Health Service Codes Nurse Practitioner codes are included in the Allied Procedure list of the Schedule of Allied Benefits. 41 billing codes available 17 direct patient services 17 direct patient services after hours 7 indirect patient care (S-codes) No modifier codes Billers can download the code file from H-Link 9 Classification: Protected A
Claims Submission Claims submission by accredited submitter via electronic H- Link method NPs required to shadow bill for service provision Shadow billing allows for tracking of service provision and patient history maintenance. Claims information include: who, what, where, when Claims must be submitted within 90 days of service provision to be assessed and processed NPs are responsible to ensure accuracy of claims submission 10 Classification: Protected A
Reviewing and Reconciling Claims Statement of Account Summarizes payment information and identifies any other payments or recoveries Statement of Assessment Report to practitioners detailing the assessment results of each claim submission. 11 Classification: Protected A
Supplementary Information Classification: Protected A
Health Professional Business Forms Alberta Health forms related to the setup under NPPCP Practitioner/Allied Practitioners Information Form AHC11234 Facility Registration AHC0910A Business Arrangement and Relationships Application AHC11236 To register practitioners/allied practitioners and professional corporations. To set up a new facility, end a facility, or change information on an existing facility. To set up a new business arrangement, change or end information on an existing business arrangement, or to change information about your relationship with an existing business arrangement. In addition, this form is used to authorize an accredited submitter to submit claims on your behalf, or to change from one submitter to another. To update your current business address to a new business address. Notification of Business Address Change AHC11459 Direct Deposit Request AHC1143 Request for Statement of Assessment/Statement of Account AHC0002 Accredited H-Link Submitter Role AHC2210 To change the direct deposit banking information for your payments To request reprints of the Statements of Assessment and Accounts To set you up yourself as your own submitter for claims submission to H-Link Additional information: Business forms: https://www.alberta.ca/health-professional-business-forms H-Link electronic claims system: https://www.alberta.ca/h-link-electronic-claims-system 13 Classification: Protected A
Contacts and Resources NPPCP contact for general inquires health.npprogram@gov.ab.ca NPPC Model description and components can be reviewed in the Nurse Practitioner Primary Care Program Guide 14 Classification: Protected A
Questions Classification: Protected A
