Name of Manual - Blue Cross and Blue Shield of Minnesota

Non-Physician Health Care Practitioners
Claims Filing
Introduction Blue Cross and its affiliates will pay for reasonable and necessary
services performed by certain non-physician health care
practitioners. Eligible services are determined by the practitioner’s
scope of practice and the member’s contract.
Eligibility Criteria Below is the eligibility criteria for non-physician health care
practitioners:
Non-physician health care practitioners must meet applicable
state or federal laws or licensing standards.
When collaboration is required, non-physician health care
practitioners in independent practice must work in
collaboration with a physician licensed in the state where the
services take place.
A non-physician health care practitioner not eligible as an
independent contractor must be an employee of a physician or
limited-license practitioner (such as chiropractor or
optometrist) licensed in the state where the services took place.
The employing provider must be legally and medically
responsible for the supervised employee’s services.
Eligible non-physician health care practitioners must apply for
and meet Blue Cross credentialing criteria.
Credentialed or enrolled practitioners must use the Blue Cross
individual provider number or NPI when submitting services.
Services rendered by supervised employees who are not issued
individual provider numbers must be submitted under the
supervising physician’s provider number or NPI. The -U7
modifier should be appended to the HCPCS code to indicate a
non-physician health care practitioner rendered the service.
Services rendered must be eligible under their Blue Cross
provider and member contracts and the practitioner’s scope of
practice.
A countersignature of notes and orders by the employing or
supervising physician is required if the non-physician
practitioner’s licensure and/or scope of practice requires a
signature.
Definitions Centers for Medicare and Medicaid Services (CMS) guidelines are
the basis for the following definitions. For added clarification, we
have further defined supervision as either direct or general.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12) 8-43