REIMBURSEMENT ISSUES

Multi-State Reimbursement Alliance

Aetna Insurance:  New APRN Credentialing Policy

Aetna Insurance New APRN Credentialing Policy Reimbursement Changes for APRN and PAs:

Beginning with June 1, 2010 dates of service, Aetna will pay APRNs & PAs at 85% of the contracted rates for covered professional services (consistent with the Centers for Medicare and Medicaid Services payment policy). This policy applies to NPs, PAs, CNM and RNs. As of June 1, providers will need to list the NP’s, etc. name in the servicing provider field when submitting claims for services rendered by approved APRNs & PAs. No party will be permitted to bill under the physician’s name or number. Patient’s seeing an NP will no longer be charged a ‘specialty co-pay.’ APRNs who are specialists can be directly credentialed by Aetna. They will be paid 85% of the physician specialist fee schedule rate. Additionally, NPs are eligible to be credentialed as primary care providers. This policy does not apply to:

  • CRNAs, registered nurse first assistants or behavioral health practitioners
  • Claims billed with an assistant surgery modifier
  • Covered DME, orthotics, prosthetics, supplies, drugs, laboratory, radiology services and immunizations bill by NPs, etc.
  • Medicare Private Fee-for-Service (non-network based)
  • Providers contracted through a third party or vendor

Aetna will be including the names of NPs, etc. in its directories.

For further information regarding this policy change, including the process for submitting NP, etc. information to Aetna, please contact your local Aetna representative. NPs that wish to be considered as a primary care provider, should reference: www.aetna.com