APPEALS: We are a large group with many physician and nonphysician practitioners. When we submit claims for nonphysician practitioners working in different sub-specialties, we receive denials that state: D984: Coverage/program guidelines not met, N20: Service not payable with other service rendered on the same day.
In addition to basic claim information, NPPs (specialty as Spec. 50 [NP] or Spec. 97 [PA]) should enter additional information, identifying the provider sub-specialty in which the service was provided. This sub-specialty information is entered on the electronic claim in the Loop 2300/2400 NTE Segment or in Box 19 of a paper claim. For example, an NPP seeing a patient within the cardiology sub-specialty area would enter Spec. 06 in the Loop 2300/2400, while an NPP seeing that same patient the same day in the psychiatry sub-specialty area would enter Spec. 26.