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Certified Registered Nurse Practitioners may apply for credentialing for our PCP network (PA and DE only)

January 9, 2014

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.

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