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Nurse practitioner credentialing

Certification, collaboration, prescribing and panel status, checked for every payer.

Nurse practitioners enroll with Medicare on the same form as physicians, but payers also check your NP certification, your state’s collaboration rules, your DEA registrations and how to list you. We handle all of it, payer by payer.

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Price
$189 per payer, less in bulk
Plan for
90–120 days, by payer
Medicare pays NPs
85% of the physician rate
NP types
FNP, AGNP, PNP, PMHNP, WHNP

What’s different for NPs

The paperwork starts the same as a physician’s: an NPI, a CAQH profile and the Medicare CMS-855I, with benefits reassigned to the practice on that same application or in PECOS. The old CMS-855R reassignment form is gone; CMS merged it into the CMS-855I in 2023.

What differs is what payers check next. For an NP enrolling today, Medicare requires state authorization to practice as an NP, certification by a recognized national certifying body, and a master’s in nursing or a DNP. Then come the questions physicians rarely get: who you collaborate with, where you may prescribe, and whether a plan will list you as a primary care provider.

As part of our provider credentialing service, we credential:

  • Family nurse practitioners (FNP) in primary care and family medicine practices
  • Adult-gerontology primary care and acute care NPs (AGPCNP, AGACNP)
  • Pediatric nurse practitioners (PNP) in pediatric practices
  • Psychiatric-mental health NPs (PMHNP), with our mental health credentialing
  • Women’s health NPs (WHNP)
  • NP-owned practices and clinics, and physician groups adding NPs
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What each payer asks of a nurse practitioner

With a complete application. Rules differ by state and by plan, so we confirm each one with the payer.

  • Documents and CAQH1 to 2 weeks, once the documents are in hand.
  • Medicare (PECOS)CMS-855I with reassignment to your group; your NP authorization, certification and degree are checked. 30 to 90 days.
  • Medicaid30 to 90 days by state, then each Medicaid managed care plan credentials you separately.
  • Commercial plans60 to 120 days, plus 2 to 6 weeks to load the contract. Each plan decides whether you join as a PCP or within a group.
  • Collaboration documentsThe collaborative or supervision agreement, where your state or the plan requires one.
  • Prescriptive authorityA DEA registration for each state where you prescribe controlled substances, plus any state registration that comes first.
  • A full set of payers90 to 120 days from a complete file to written effective dates.

Not enrolled means not paid.

A provider who isn’t credentialed can still see patients. They just can’t bill for them. Pick a start date and the payers you need to see where the gap falls.

Start credentialing the day you sign the contract, not the day your provider starts seeing patients.

Plan a new provider’s start

13weeks of visits could fall before an effective date

With a start in 1 month, Medicare could be effective in 30 to 90 days and commercial plans in 60 to 120.

Starts seeing patients in
Payers to enroll with

Typical ranges with a complete application; commercial plans can need 2 to 6 more weeks to load the contract. Each payer sets its own pace, so we track every application to an effective date in writing.

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State practice authority and collaboration agreements

Your state’s practice rules decide how much paperwork rides along with each application. The American Association of Nurse Practitioners groups states into three practice environments: full practice, where NPs diagnose, treat and prescribe under the board of nursing alone; reduced practice, where state law requires a career-long collaborative agreement or limits the setting of at least one element of NP practice; and restricted practice, where it requires career-long supervision, delegation or team management by another provider.

Medicare covers NP services only when they are performed in collaboration with a physician, as your state defines it. Where state law is silent, you document your scope of practice and the physicians you turn to for issues outside it. The physician does not have to be present or see each patient.

Prescribing is a separate track. DEA requires a separate registration in each state where you prescribe controlled substances, and the state decides which schedules you may handle. Some states add a step: Missouri requires an APRN to hold a state BNDD registration before applying to DEA, and the BNDD application must include the collaborative practice arrangement.

We collect the agreement and every DEA and state registration up front, and check that they match on CAQH and every payer form before filing.

Your own panel, a group contract, or incident-to billing

Commercial and Medicaid plans decide how to contract with NPs within state law, and one plan’s products can differ. Under Fallon Health’s nurse practitioner payment policy in Massachusetts, an NP may join as a primary care provider, a physician extender or a provider without a panel. Whether an NP is listed as a PCP depends on the specialty they are credentialed in, and a collaborative agreement is required for its Medicare HMO but not, once the NP meets the state’s independent-practice criteria, for its commercial or MassHealth plans.

Medicare allows 85% of the physician fee schedule amount for services you bill under your own NPI. In an office or clinic, billing under a supervising physician’s NPI at 100% of the fee schedule is allowed only for incident-to services, and only when all of these hold:

  • The physician performed the initial service and stays actively involved in the course of treatment.
  • The service is the kind given in an office or clinic, not in a hospital or skilled nursing facility.
  • You are an employee, leased employee or contractor of the physician or the billing practice.
  • The physician provides direct supervision, which may be by real-time audio and video (not audio-only) for services without a 010 or 090 global period.
  • Only the supervising physician bills for the service.

Commercial plans set their own incident-to rules; Fallon’s adds a physician co-signature on the date of service. Our medical billing team checks each NP claim against the right rule before it goes out.

What credentialing costs

Priced per payer application, so you pay only for the enrollments you need. The more payers you add, the less each one costs.

  • Standard rate

    $189

    per payer application.

  • Up to 7 payers

    $150

    per payer application when you enroll with several payers at once.

  • Up to 20 payers

    $120

    per payer application for a larger rollout.

Every application includes

  • A CAQH ProView check and update
  • The payer application, filed in that payer’s format
  • Weekly payer follow-up until approval
  • The effective date confirmed in writing
  • EFT and ERA setup so payments arrive
  • No setup fee

Each application covers one provider with one payer. Your price is confirmed in writing before we start.

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How we credential NPs

  1. Check the NP and the state rules

    We confirm license, national certification, degree and NPI taxonomy, and map your state’s practice authority and collaboration requirements.

  2. Line up prescribing documents

    We check that DEA and state controlled-substance registrations cover every state and location on the applications.

  3. Build CAQH and the group

    CAQH built or cleaned up and attested. For an NP-owned practice, the group NPI and Medicare group enrollment on the CMS-855B.

  4. File every payer

    Each NP on the CMS-855I with reassignment, then Medicaid, each managed care plan and commercial plans, asking each how it will list the NP.

  5. Follow up until approved

    Weekly payer calls and portal checks, with a live status tracker for every NP and payer.

  6. Confirm and keep it current

    Effective dates and panel status in writing, EFT and ERA set up, and revalidation and re-credentialing dates on a calendar we watch.

What we need from you

For each nurse practitioner, plus the practice details once:

  • NPI and NP taxonomy
  • State RN and NP or APRN license
  • National NP certification
  • Master’s or DNP diploma
  • DEA and state CDS registrations
  • Collaboration agreement, if required
  • Malpractice certificate of insurance
  • CV with a gap-free work history
  • Tax ID, W-9 and voided check

Questions NPs ask

Something else? Call +1 786-788-7313. A credentialing specialist answers.

All questions

Get an NPI with the nurse practitioner taxonomy and build and attest a CAQH profile. Enroll with Medicare on the CMS-855I in PECOS, reassigning benefits to your practice. Then file with state Medicaid and with each Medicaid managed care plan, since each plan runs its own credentialing, and with commercial plans whose panels are open.

Plan on 90 to 120 days for a full set of payers, the same as for physicians. Medicare and Medicaid usually take 30 to 90 days; commercial plans take 60 to 120 days, plus 2 to 6 weeks to load the contract. A missing collaboration agreement or DEA registration can add weeks, so we collect both first.

It depends on the plan and the state. A plan may contract an NP as a primary care provider with their own panel, as a physician extender, or only within a contracted group, and one plan’s commercial, Medicare and Medicaid products can differ. We ask each plan how it will list you before we apply, and get the answer in writing.

Yes. Medicare allows 85% of the physician fee schedule amount for services an NP bills under their own NPI. Incident-to services billed under a supervising physician are paid at 100%, but only when every incident-to condition is met, including direct supervision. Commercial plans set their own rates.

It depends on your state and the plan. Full practice states let NPs practice under the board of nursing alone; reduced practice states require a collaborative agreement or limit where you practice, and restricted practice states require supervision. Medicare requires collaboration as your state defines it. A plan can also require one for some products, as Fallon Health does for its Medicare HMO.

Yes, in every state where you prescribe controlled substances. DEA issues a separate registration per state, based on that state’s authority, and the state sets which schedules you may prescribe. Some states, Missouri among them, also require a state controlled-substance registration first. We check that yours cover every state and location on your applications.

The same as for any provider: $189 per payer application, or $150 per payer for up to 7 payers and $120 per payer for up to 20, with no setup fee. Each application covers one NP with one payer and includes the CAQH check, weekly follow-up, the effective date in writing, and EFT and ERA setup.

Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.

From our guides

Specialties we credential

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Adding a nurse practitioner?

Send us the NP’s state, specialty and the payers you need. We’ll map what each payer asks for and the effective dates to plan around, free.

Start credentialing+1 786-788-7313