AmeriHealth is updating its policy on reimbursing certified registered nurse practitioners (CRNP) to include physician assistants (PA). Claim Payment Policy #00.10.40b: Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNPs) or Physician Assistants (PAs) was posted as a Notification on November 1, 2017, and will go into effect December 1, 2017.

As part of the update, PAs who are working in a participating primary care physician (PCP) or specialty physician group may become credentialed as a participating provider effective December 1, 2017.

Services performed on a fee-for-service basis by a PA will be reimbursed based on the terms of their AmeriHealth Professional Provider Agreement. Payment for services rendered will be based on 85 percent of the standard physician fee schedule.

Note: There are certain specialties to which this policy does not apply, including hospital-based specialties (e.g., hospitalist, emergency room, radiologist, neonatology) and urgent care practices.

For more information

To view the Notification for this expanded policy, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial under Active Notifications.