In accordance with Medi-Cal guidelines, claims submitted for services rendered by non-medical practitioners (NMPs) and billed with modifiers U7 or SA must include the NMP’s:
- Lub npe.
- National Provider Identifier (NPI).
- Provider type.
The Alliance denies claims that do not include the required NMP documentation. However, due to a temporary processing error, some claims missing this documentation were inadvertently paid during a recent period.
This issue has been corrected and the standard claim review process has resumed. Effective immediately, any claims submitted without the necessary NMP documentation will be denied in accordance with Medi-Cal requirements.
For more information, you can review the full Medi-Cal guidelines for NMP billing. If you have any additional questions, please call the Alliance’s Claims Customer Service Line at 831-430-5503.
We appreciate your attention to this matter and your continued partnership in ensuring compliance with billing standards.
