​​​​CRNP and PA credentialing and reimbursement

October 7, 2021

Certified Registered Nurse Practitioners (CRNP) and Physician Assistants (PA) are a vital part of the AmeriHealth network of providers. All CRNPs and PAs must be credentialed to provide independent, unsupervised services to AmeriHealth members. This allows non-physician practitioners to help meet their patients' health care demands and aligns with CMS and industry standards. We shared updated contracting and credentialing scenario​s on May 20, 2021.

If you are not yet credentialed, please visit the AmeriHealth New Jersey or AmeriHealth Pennsylvania Professional Provider Credentialing webpages for to review the criteria and apply.

Reimbursement guidelines

Follow these billing guidelines when submitting claims to ensure proper coding and payment:

  • Incident to services. When a credentialed CRNP or PA performs these services, the supervising physician must bill using his or her own NPI and code with the SA modifier (nurse practitioner rendering service in collaboration with a physician).
  • Non-incident to services. The credentialed CRNP or PA who performed the service must bill using his or her own NPI.

Please read #00.10.40d: Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs) to learn more.