Last Updated: Apr 25, 2019
Independence Blue Cross (IBC) is updating its credentialing and reimbursement policies for certified registered nurse practitioners (CRNPs) and physician assistants (PAs).
IBC’s credentialing policy for CRNPs and PAs will take effect on June 1, 2019. CRNPs and PAs will be required to be credentialed in order to render services or to bill using their own NPI number. Also, under the new requirements, CRNPs and PAs can see an IBC member for an initial visit but they would not be able to bill "incident to" for that visit.
IBC began accepting CRNP and PA credentialing applications on Jan. 1, 2019. Any applications received through April 1 will be processed before June 1.
Credentialing applications received after April 1 may not be processed prior to the policy’s effective date. CRNPs and PAs who are not credentialed by June 1 will not be able to render services to IBC members.
Any practitioners who are already credentialed do not need to submit a credentialing application.
Incident To Policy for CRNPs and PAs
Understanding "Incident To" Billing
PAMED provides answers to FAQs
Effective June 1, 2019, IBC will follow Centers for Medicare and Medicaid Services (CMS) guidelines for “incident to” billing. IBC’s new reimbursement policy is as follows:
- “Incident to” services (i.e., services performed by a CRNP or PA in an outpatient setting under the direct supervision of a supervising physician) will be paid at 100 percent of the standard physician fee schedule, subject to the terms and conditions of the participation agreement. The supervising physician should bill using their own National Provider Identifier (NPI) number and report modifier SA.
- “Non-incident to” services will be paid at 85 percent of the standard physician fee schedule, subject to the specific terms and conditions of the participation agreement that covers the CRNP or PA. The CRNP or PA who performed the service should bill using their own NPI number.
This reimbursement policy does not apply to hospital-based specialties or urgent care practices. Additionally, covered vaccines and injectables are eligible to be reimbursed at 100 percent of the standard vaccine and injectable fee schedule. Refer to IBC’s policy for more details.
IBC offers more information on these policy changes via the links below:
Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.