Nurse Faculty Practice Network
Credentialing
To become a billing provider, an advanced practice nurse must go through the payer credentialing process. First, a nurse practitioner or certified nurse midwife must meet all requirements for state licensure and have a certificate of fitness. Once a determination has been made on where the advanced practice nurse will practice, a Medicare application requesting a provider identification number must be completed. This may be obtained from the state specific Medicare intermediary. You will need to have the tax identification number of the practice and the practice address so that you may complete the form. It takes approximately 45 days for the site specific Medicare number to be generated. Many institutions have a professional staff office that will assist the advanced practice nurse in obtaining this number.
Once a Medicare number is received, the advanced practice nurse must submit applications to all other payers with whom he/she wishes to contract. The process may take anywhere from 30 to 120 days. It is important to remember that the rules for credentialing and reimbursing advanced practice nurses vary across the health plans.
For more information, contact Deborah Fertitta at 615-343-3250.