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Last year, Independence began to accept credentialing applications for
Certified Registered Nurse Practitioners (CRNP) employed by participating
primary care physician (PCP) practices. As of January 1, 2015, Independence
requires Individual Agreements or Amendments to Professional Group Provider
Agreements for these CRNPs to be participating providers.
Once contracted, CRNPs may bill directly for their services as the
performing provider using the following elements:
- PCP group tax identification number;
- PCP group NPI number;
- CRNP's individual NPI number;
- CRNP's detailed taxonomy code.
To review our policy on the reimbursement for CRNP services, visit our Medical Policy portal.
Select Accept and Go to Medical Policy Online, and then select the
Commercial or Medicare Advantage tab from the top of the page,
depending on the version you'd like to view. Then type the policy name or
number in the Search field:
- Commercial: #00.10.40: Reimbursement for Certified Registered Nurse
Practitioners (CRNP);
- Medicare Advantage: #MA00.045: Reimbursement for Certified
Registered Nurse Practitioners (CRNP).
You can also view policy activity through the
NaviNet® web portal by selecting the
Reference Tools transaction, then
Medical Policy.
Obtaining credentialing
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 found at the CAQH Proview™
website. Once the form is completed, providers should notify our Provider
Networks and Value-Based Solutions Administration Department at Application_Requests@ibx.com.
Please include the following information in your email:
- CRNP's name;
- CRNP's mailing address ? should be same as PCP Group's mailing address;
- CRNP's office address ? should be same as PCP Group's office address;
- CRNP's CAQH ID number;
- CRNP's NPI;
- CRNP's Group NPI ? should be same as PCP Group's Group NPI;
- taxonomy code;
- contact person's name, telephone number, and email address.
If you have any questions regarding this process, please contact Customer
Service at 1-800-ASK-BLUE.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.
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