A Certified registered nurse practitioner (CRNP) must meet all the requirements of the
AmeriHealth New Jersey and
AmeriHealth Pennsylvania credentialing criteria
and have a collaborative agreement with a participating physician who holds a current and unrestricted license. The training and scope of practice of the collaborating physician must be consistent with the practice of the CRNP.
The agreement must comply with current applicable state and federal regulations.
If you have already been credentialed, there is no need to resubmit a credentialing application.
Contracting and credentialing scenarios
CRNP credentialing requirement:
| Physician PCP office | Required | CRNPs bill under their own National Provider Identifier (NPI) number unless service meets “incident to" guidelines (physician does not need to be in the office for CRNP to see members). |
| CRNP-only PCP office (no physician present) | Required | CRNPs must have a collaborative physician agreement. |
| Physician specialist office | Required | CRNPs bill under their own NPI number unless it meets “incident to" guidelines.
A physician must be present in the office for at least 75 percent of the hours in which the office is scheduling patients for a CRNP to be contracted and credentialed with AmeriHealth. |
| CRNP-only hospital or nursing home practice | Not allowed | |
Policy
Please visit our
Medical & Claim Payment Policy Portal to view Claim Payment Policy: #00.10.40d: Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs).
Frequently Asked Questions
The information in this article is available in our
Updated credentialing requirements and reimbursement position for CRNPs (FAQ). The FAQ will be updated as more information becomes available.
Learn more
To learn more about CRNP direct supervision requirements during COVID-19, please read our
article.
To complete the credentialing process, please visit the
AmeriHealth New Jersey or
AmeriHealth Pennsylvania Professional Provider Credentialing webpages.