Effective April 1, 2014, AmeriHealth New Jersey will
begin providing the option for Certified Registered
Nurse Practitioners (CRNP) who are practicing
independently within a participating primary care
physician practice to be recognized as a participating
provider. To elect this option, a CRNP must complete
the credentialing and contracting process. Once
completed, CRNPs may bill directly for their services
as the performing provider using their newly assigned
provider number.
Reimbursement for CRNP services shall be made
in accordance with AmeriHealth medical and claim
payment policies and, where applicable, the contracted
CRNP fee schedule. In the event a CRNP fee schedule
is not included in the contract, reimbursement shall
be based on 85 percent of the applicable contracted
professional fee schedule. Reimbursement for covered
vaccines shall be based on 100 percent of the
applicable contracted professional fee schedule.
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. Once the form is completed,
providers should notify our Contracting Provider
Network Contract Administration Department by
calling 1-866-227-2186.
Please have the following information available
when you call:
- CRNP's name
- CRNP's mailing address
- CRNP's office address
- CRNP's CAQH ID number
- CRNP's NPI (Note: A group NPI for the CRNPs
in your office will need to be provided.)
- contact person's name, telephone number, and
email address.
If you have any questions regarding this process,
please contact Customer Service at 1-888-YOUR-AH1
(1-888-986-7241).