Enrollment of physician assistants in New Hampshire

Benefits of enrolling your physician assistants

Enrolling physician assistants (PAs) allows us to include these providers in our provider directories so that our members — your patients — can easily search for participating PAs.

In addition, enrolling PAs allows 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 are processed under the participating PA record, without any rebilling 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.

This is a reminder to enroll any PA associated with your practice. Once enrollment confirmation and the effective date is communicated by Anthem to the practice, PAs may bill their services under their own 10-digit National Provider Identifier (NPI).

How Anthem’s enrollment process works

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 is the same as the current standard physician allowance for our commercial and Pathway plan agreements. For Medicare Advantage, we 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.

Several options are available for your group to enroll PAs. Standard enrollment is either through the Digital Provider Enrollment process at 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 edition of Provider News. Here are links to the Rules of Engagement as well as the template:

• Roster Automation Rules of Engagement (PDF)
• Roster Automation Standard Template (Excel)

Please note that all PAs, unless hospital based, require credentialing (more on this below). PAs are required to bill under their own NPI upon completion of their enrollment or approval by credentialing (if applicable) for any services provided as of their effective date. For any PA in the process of being credentialed or enrolled, who is not yet approved, 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 in your practice are encouraged to enroll.

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

Credentialing

PAs are required to be credentialed through Anthem if they are not considered hospital based. When completing the enrollment, ensure that the provider data on CAQH (Council for Affordable Quality Healthcare) is current and in a complete or re-attested status for providers requiring credentialing.

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, you can then begin billing claims for the PA using their own individual NPI as of the effective date of enrollment stated in the welcome letter.