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CRNP policies expanded to include services performed in a specialist’s group

June 30, 2017

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.


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