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Last year, AmeriHealth began to accept credentialing applications for
Certified Registered Nurse Practitioners (CRNP) employed by participating
primary care physician (PCP) practices. As of January 1, 2015, AmeriHealth
requires Individual Agreements or Amendments to Professional Group Provider
Agreements for these CRNPs to be participating providers.
Once contracted, CRNPs may bill directly for their services as the
performing provider using the following elements:
- PCP group tax identification number;
- PCP group NPI number;
- CRNP's individual NPI number;
- CRNP's detailed taxonomy code.
To review our policy on the reimbursement for CRNP services, visit our Medical Policy
portal. Select Accept and Go to Medical Policy Online, and then
select the Commercial or Medicare Advantage tab from the top of
the page, depending on the version you'd like to view. Then type the policy
name or number in the Search field:
- Commercial: #00.10.40: Reimbursement for Certified Registered Nurse
Practitioners (CRNP);
- Medicare Advantage: #MA00.045: Reimbursement for Certified
Registered Nurse Practitioners (CRNP).
You can also view policy activity through the
NaviNet® web portal by selecting the
Reference Tools transaction, then
Medical Policy.
Obtaining credentialing
If your PCP practice is interested in credentialing a CRNP as a PCP to
participate in our network, please complete the
Council for Affordable Quality Healthcare (CAQH) credentialing form found at
the CAQH Proview™
website. Once the form is completed, providers should notify us at
Application_Requests@amerihealth.com. Please include the following
information in your email:
- CRNP's name;
- CRNP's mailing address ? should be same as PCP Group's mailing address;
- CRNP's office address ? should be same as PCP Group's office address;
- CRNP's CAQH ID number;
- CRNP's NPI;
- CRNP's Group NPI ? should be same as PCP Group's Group NPI;
- taxonomy code;
- contact person's name, telephone number, and email address.
Note: Providers in New Jersey can also use the New Jersey Universal
Physician Application form.
If you have any questions regarding this process, please contact Customer
Service at 1-800-275-2583 for credentialing for AmeriHealth Pennsylvania
or 1-888-YOUR-AH1 (1-888-968-7241) for credentialing for
AmeriHealth New Jersey.
NaviNet is a registered trademark of NaviNet, Inc.
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