Independence is updating its policies on reimbursing certified registered
nurse practitioners (CRNP) to include services performed in a specialist?s
group. The following policies were posted as Notifications on June 30, 2017,
and will go into effect August 1, 2017:
- Commercial: #00.10.40a: Reimbursement for Services
Performed by Certified Registered Nurse Practitioners (CRNP)
- Medicare Advantage: #MA00.045a: Reimbursement for Services
Performed by Certified Registered Nurse Practitioners (CRNP)
As part of the update, CRNPs who are working in a participating specialist?s
group may become credentialed as a participating provider effective August 1,
2017.
Services performed on a fee-for-service basis by a CRNP will be reimbursed
based on the terms of their Professional Provider Agreement. Payment for
services rendered will be based on 85 percent of the standard physician fee
schedule.
Becoming a credentialed CRNP after August 1,
2017
Requests for participation in our network as a CRNP specialist can be
submitted after August 1, 2017. Please do
not submit requests for participation prior to August
1, 2017. The Provider Participation Form can be found on our Professional
Provider Credentialing webpage.
Any professional provider interested in participating in our network must
complete and return a credentialing application kit. You can simplify this
process by using the Council for Affordable Quality Healthcare?s (CAQH) online
credentialing application: CAQH ProView™.
A complete list of credentialing criteria applicants must adhere to can be
found here.
For more information
To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical
Policy Online, and then select Commercial or Medicare
Advantage under Active Notifications.