Contracting and credentialing nurse practitioners and physician assistants

Virginia House Bill 1640 requires payers to offer provider contracting opportunities to nurse practitioners who meet payer terms and conditions effective October 1, 2019.  Anthem Blue Cross and Blue Shield in Virginia and our affiliate HealthKeepers, Inc. are now directly contracting and credentialing nurse practitioners (NPs) and physician assistants (PAs).  We are contracting with NPs and PAs who are licensed by the Virginia Board of Nursing and/or the Virginia Board of Medicine.

 

Previously, licensed NPs and PAs could only bill for covered services under the supervision of the employing/supervising participating physician using that physician’s name and National Provider Identifier (NPI) number. Direct contracting means NPs and PAs must bill Anthem directly for their services, and the “incident to” guidelines will no longer apply.  Direct contracting and credentialing of NPs and PAs also allows us to include NPs and PAs in our provider directories as independent providers, and our members – your patients – can easily search our Provider Finder tool for NPs and PAs who participate with their health plan.

 

In addition, direct contracting with NPs and PAs will allow easier handling of Medicare crossover claims. Medicare crossover claims for services provided by NPs and PAs to our members with a secondary group coverage policy will process under the participating NP or PA record, all without any re-billing by the group under the physician’s NPI.

 

In order to be participating providers in our networks, NPs and PAs will need to sign agreements and be credentialed by Anthem. NPs and PAs must complete the online credentialing application process through CAQH.  [To contact CAQH, dial 888-599-1771 (Monday -Thursday 7 a.m. - 9 p.m. ET; Friday 7 a.m. - 7 p.m. ET), or visit the CAQH website at http://www.caqh.org/ucd_physician_register.php.]

 

Effective March 1, 2020, we will no longer allow NP and PA services to be billed incident to physician services. So providers should take action right away to initiate contracting and credentialing.

 

If you or other providers in your organization meet the aforementioned requirements, please utilize our online provider enrollment application through the provider portal on Availity at https://www.availity.com/. Or, you may reach out to your designated network manager directly. Contact information can be found at https://www.anthem.com/provider/contact-us/