AmeriHealth is updating 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) was posted as a Notification on
June 30, 2017, and will go into effect August 1, 2017.
As part of the update, CRNPs who are working in a participating specialist?s
group may become credentialed as a participating provider effective August 1,
2017.
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.
Becoming a credentialed CRNP after August 1,
2017
Requests for participation in our network as a CRNP specialist can be
submitted after August 1, 2017. Please do
not submit requests for participation prior to August
1, 2017. The Provider Participation Form can be found on our
credentialing webpages for AmeriHealth New Jersey and
AmeriHealth
Pennsylvania.
Any professional provider interested in participating in our network must
complete and return a credentialing application kit. You can simplify this
process by using the Council for Affordable Quality Healthcare?s (CAQH) online
credentialing application: CAQH ProView™.
A complete list of credentialing criteria applicants must adhere is
available for AmeriHealth New Jersey
and AmeriHealth
Pennsylvania.
For more information
To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical
Policy Online, and then select Commercial under Active
Notifications.