​Important reminder! CRNP contracting and credentialing

August 20, 2020

Certified registered nurse practitioners (CRNPs) provide health care to all age groups of patients based on their training. For example, CRNPs perform comprehensive and focused physical examinations, diagnose and treat common illnesses and injuries, provide immunizations and education, and manage high blood pressure, diabetes, and other chronic health problems. CRNPs can order and interpret diagnostic tests, such as X-rays, EKGs, and laboratory tests. They can also prescribe medications and therapies and can perform certain procedures (based on state/national practice guidelines). 

Contracting and credentialing requirements

A CRNP must meet all the AmeriHealth New Jersey and AmeriHealth Pennsylvania credentialing criteria requirements 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

CRNPs are only permitted to be contracted and credentialed with AmeriHealth under these scenarios:

Scenario Allowed/Not allowed Notes

Physician PCP office

Allowed

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)

Allowed

CRNPs must have a collaborative physician agreement.

Physician specialist office

Allowed

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 specialist office

Not allowed

 

CRNP-only hospital or nursing home practice

Not allowed

 

Policy

Please visit our Medical Policy Portal to view Claim Payment Policy: #00.10.40c: Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs) regarding reimbursing CRNPs.

Frequently Asked Questions

The information in this article is available in our Updated credentialing requirements and reimbursement position for CRNPs and PAs (FAQ), which can also be found in the Frequently Asked Questions archive on AmeriHealth NaviNet® web portal (NaviNet Open) Plan Central or in the Quick Links menu on the right-hand side of this page. 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.

NaviNet® is a registered trademark of NantHealth.