Commercial Insurance

Commercial insurers recognize the services PAs provide in most settings. Insurance companies have developed their policies that may be, not only different in each state, but different in each region. The billers in a medical practice or group should familiarize themselves with each plan’s policy and mechanism for reimbursing services provided by PAs. Remember, reimbursement is not for “PA services” but rather for physician medical services provided by a PA.

Most commercial insurers request that the bill be submitted under the name and identifier of the “contracted” physician – but confirm that with each company. Also if they say to just bill for services provided by the PA “incident to” – meaning under the physician – be aware that that does not necessarily mean that the strict Medicare incident to rules apply. They typically do not.

Most commercial insurers do not “credential” PAs because they are not the “contracted provider with the insurance company.” Discussions suggest that this may change in the future.

AAPA Reimbursement Information