Harvard Pilgrim is updating our commercial claims submission requirements for contracted physicians reporting services on behalf of non-physician practitioners who are not contracted with Harvard Pilgrim.
For commercial claims with dates of service beginning Jan. 1, 2019, when a Harvard Pilgrim-contracted physician is reporting on behalf of a nurse practitioner, physician assistant, or clinical nurse specialist who is not contracted with Harvard Pilgrim, the physician will be required to document this by appending modifier SA to the claim. Additionally, the NPI of the supervising physician will need to be documented in field 24J on the CMS-1500 claim form or its electronic equivalent. Modifier SA should not be appended to a claim for a service provided by a non-physician practitioner who is contracted directly with Harvard Pilgrim.
While the inclusion of modifier SA will be required to indicate that the physician is documenting the care on behalf of a non-physician practitioner, appending this modifier to the claim will not have any effect on reimbursement. For more information, please refer to Harvard Pilgrim’s updated Certified Nurse Midwives, Certified Professional Midwives, Nurse Practitioners, and Physician Assistants Payment Policy.