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Clarification to the CRNP policies for services performed in a specialist’s group

August 31, 2017

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As previously communicated, effective August 1, 2017, Independence updated the following policies on reimbursing certified registered nurse practitioners (CRNP) to include services performed in a specialist?s group:

  • 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)

Clarification to the policies

There are certain specialties to which these policies do NOT apply; therefore, the following language was added to the policies on August 22, 2017:

    This policy does not apply to hospital-based specialties (e.g., hospitalist, emergency room, radiologist, neonatology) and urgent care practices.

As per the policies, CRNPs who are working in a participating specialist?s group may become credentialed as a participating provider.

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.

For more information

To view these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page and type the policy name or number in the Search field.

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