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CareFirst billing

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  • Wendy Belding

    Hi Rachel,

    Here's the situation with TriWest.  CareFirst may or may not be the same.  You can always submit with and without, then file a "corrected" claim if needed for the one that rejects and/or pays less.

    Place of Service (PoS)/Modifier:

    • 11/95: if you would have seen them in the office,
      but do telehealth instead due to COVID (most clients)
      - this will end one day.  This pays the "in-person" rate:
      some 12% more at TriWest than telehealth does.
    • 11 [no modifier needed]: typical in-person office or walking session.
    • 02/GT (or 02/95 or just 02)*: typical telehealth – people far away
      that would have been telehealth anyway. 
      Pays about 10% less than "in-person."

    (*You might have to try different ones to see what clears with your payer.  This is what works for TriWest and Tricare.)

    You can default a client's sessions to the “GT” just like you default the "95" at Client Main Page / Edit at the top / Billing and Insurance / Client Default Services / fill in the service and modifier.  (Note: if someone already has recurring sessions in the calendar, those don't change.  New appointments only.  Just change the upcoming session on a recurring and select "this and all future sessions.")

    We put "Telehealth Office" to default to PoS "11" at Settings / My Practice / Locations / Teleheath - "Edit" because most people would have been an "11."  That means actual Telehelath clients that would have been Telehealth anyway (and have a GT modifier) have to have their PoS edited in the drop down to 02 on their claims.

    When all goes back to normal, we'll set "Telehealth Office" to default to 02 and those claims will need no editing.

    Good luck!

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