Begin enrolling PAs in New Hampshire for dates of service beginning July 1, 2023

Benefits of enrolling your Physician Assistants (PAs)

Enrolling PAs will allow us to include these providers in our provider directories allowing our members – your patients – to easily search our provider finder tool for PAs who participate with members’ health plans.

In addition, enrolling PAs will allow easier handling of both commercial claims as well as Medicare crossover claims. Medicare crossover claims for services provided by PAs to our members with a secondary group coverage policy will process under the participating PA record, without any re-billing by the group under the supervising physician’s NPI. Another benefit includes accurate processing of assistant surgeon claims currently billed under the surgeon’s NPI.

How the Anthem enrollment process will work

The process to begin enrolling PAs starts now, with provider effective dates on or after July 1, 2023, pending credentialing approval.

PAs must be practicing in a group practice that has at least one MD or DO in the practice for which a collaboration agreement exists. PAs cannot hold an independent agreement with Anthem.

The reimbursement fee schedule will be the same as the current standard physician allowance for our Commercial and Pathway plan agreements. For Medicare Advantage, we will reimburse PA services at the Medicare rate. All applicable modifier rules apply.

Please note that PAs cannot hold a primary care physician (PCP) panel of patients; however, they can be enrolled as a PCP for those services in which they may cover for an existing PCP. Anthem will display PAs requesting to be PCPs with a closed panel.

Starting immediately, PAs can begin enrolling with Anthem and for service dates beginning July 1, 2023. Once enrollment confirmation and effective date is communicated by Anthem to the practice, PAs may bill their services under their own 10-digit National Provider Identifier (NPI). All existing PAs are encouraged to enroll no later than December 31, 2023.

There are several options available for your group to enroll PAs. The standard enrollment process using the Digital Provider Enrollment process through Availity Essentials* or with the new Roster Automation (RA) process. RA was created to drive a standardized intake method that allows the ability to autoload changes. This technology will significantly reduce the turnaround time and drive quality through standardization and programmed business rules improving provider data accuracy. For more information on what RA is and what this means to you, please refer to the June 2023 Provider News regarding RA. Below you will find the links to the RA Rules of Engagement as well as the Standard Template:

• Roster Automation Rules of Engagement
• Roster Automation Standard Template

Please note that some providers may require credentialing. PAs will be required to bill under their own NPI upon completion of their enrollment or approval by credentialing (if applicable) for any services provided as of July 1, 2023. For any PA in the process of being credentialed or enrolled on July 1, 2023, claims should continue to be billed under the supervising NPI until the PA is enrolled and has received a welcome letter with their effective date. Again, existing PAs are encouraged to enroll no later December 31, 2023.

This effort will impact all our lines of business including, but not limited to, our Commercial plans, Federal Employee Program^® (FEP) health plans purchased on or off the Health Insurance Marketplace (Pathway plans), and our Medicare Advantage health plans.

Credentialing

PAs will be required to be credentialed through Anthem in New Hampshire if they are not considered hospital based. When completing the enrollment process, please ensure the provider data on CAQH is current and in a complete or re-attested status for providers requiring credentialing.

Please always wait to receive notification that the PA has been approved and loaded to our system by way of the welcome letter. Once the welcome letter is received, PAs can begin billing claims for the PA using their own individual NPI as of the effective date of enrollment stated in the welcome letter.