CAPPA ANNOUNCES DOULA INSURANCE REIMBURSEMENT
Lawrenceville, GA, USA, October 12, 2009.
Effective October 1, 2009, the National Uniform Claim Committee (NUCC) has approved and defined a taxonomy code for certified doulas in the United States. This code will enable certified doulas to obtain an NPI (National Provider Identification) number to submit reimbursement claims to Medicaid and third-party provider insurance companies.
Applying for your NPI number:
The new taxonomy code is 374J00000X and is called "Doula" under the heading of "Nursing Service Related Providers Type." Although it is listed under the "Nursing" heading, it is not required to be an RN or LPN to obtain an NPI number. The description includes the services of labor doulas, postpartum doulas, and antepartum doulas. "Doulas work in a variety of settings and have been trained to provide physical, emotional, and information support to a mother before, during, and just after birth and/or provide emotional and practical support to a mother during the postpartum period." http://www.nucc.org/index.php?option=com_content&task=view&id=108&Itemid=58
Application standards are in the final stages of development, but one thing is already clear. Certification credentials will be necessary to apply. Only certified doulas will be able to use this code to apply for an NPI number or for reimbursement.
Application for an NPI number can be made using the new taxonomy code at the National Plan and Provider Enumerator Systems (NPPES) website: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions
While group practices may be allowed to apply for a number, it is strongly suggested by NPPES that each individual certified doula apply for her own NPI number.
Billing for Medicaid/Insurance Reimbursement:
The taxonomy code and NPI number do not guarantee reimbursement, but they do remove the major obstacles to reimbursement that have existed up to this point.
Continue to use appropriate contracts with your clients. Billing your clients directly and offering them reimbursement when we receive payment from the insurance companies will create the best opportunity for consistent insurance billing to become a reality. Once everything starts working more smoothly, we may be in a better position to bill directly.
A standard billing form is in development and will be available shortly. In the meantime, a 1500 Universal Claims Form can be used to bill for reimbursement. These forms can be ordered online or purchased at any medical supply store.
Billing standards for labor doulas are in the final stages of development. CAPPA will release those amounts as soon as they are finalized. We feel confident that suggested billing amounts will be much more commensurate with the work involved than is reflected in many regional fee structures.
Billing standards for postpartum and antepartum doulas are still in development and may take a little longer as they are much more complex.
In order to become a "Medicaid Provider", a separate application process must be completed. This process varies by state, but will require the taxonomy code and NPI number. Check for application instructions on your state website.
CAPPA will be sending out further information on billing standards, forms, and other developments as they become available. We will strive to answer all your questions in a timely fashion. Please direct your questions to your program director as follows:
Labor Doula Programs: firstname.lastname@example.org
Antepartum Doula Program: email@example.com
Postpartum Doula Programs: firstname.lastname@example.org
We owe a deep debt of gratitude to Pat Burrell, RN, CD for working tirelessly over the last year to obtain assignment of this code. Pat is continuing to spearhead the effort to finalize details of this exciting development. If you have a question that cannot be answered by your program director, or if you simply wish to express your thanks to Pat, she can be reached at email@example.com
CAPPA can be contacted at 1-888-My-CAPPA
or visit our web site at www.cappa.net