CRNP contracting, credentialing, and collaborative agreements

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CRNP contracting, credentialing, and collaborative agreements

May 20, 2021

This article contains new information about contracting & credentialing scenarios.

A Certified registered nurse practitioner (CRNP) must meet all the requirements of Independence's 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:

Scenario	Required / Not allowed	Notes
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 Independence.
CRNP-only hospital or nursing home practice	Not allowed

Policy

Please visit our Medical & Claim Payment Policy Portal to view the current Independence policies on reimbursing CRNPs:

Commercial: #00.10.40d: Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
Medicare Advantage: #MA00.045d: Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)