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As previously communicated, AmeriHealth updated its policy on reimbursing
certified registered nurse practitioners (CRNP) to include services performed
in a specialist?s group. Claim Payment Policy #00.10.40a: Reimbursement for
Services Performed by Certified Registered Nurse Practitioners (CRNP) went into
effect August 1, 2017.
Clarification to the policy
There are certain specialties to which this policy does NOT apply;
therefore, the following language was added to the policy on August 22,
2017:
This policy does not apply to hospital-based specialties
(e.g., hospitalist, emergency room, radiologist, neonatology) and urgent care
practices.
As per the policy, CRNPs who are working in a participating specialist?s
group may become credentialed as a participating provider.
Services performed on a fee-for-service basis by a CRNP will be reimbursed
based on the terms of their professional provider Agreement. Payment for
services rendered will be based on 85 percent of the standard physician fee
schedule.
For more information
To view this policy, visit our Medical Policy Portal. Select
Accept and Go to Medical Policy Online, and then select the
Commercial tab from the top of the page and type the policy name or
number in the Search field.
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