Effective January 1, 2014, AmeriHealth began providing the
option for Certified Registered Nurse Practitioners (CRNPs), 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 at
Application_Requests@amerihealth.com.
Please include the following information in your email:
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
1-800-275-2583.