Wiki Billing in the state of Maine for Nurse Practitioners

[dcrossman]

Hello All-

I am wondering if any of you know the process for credentialing/enrolling a Nurse Practitioner so they can bill under their own NPI without requiring a supervision provider in MAINE. I have contacted Maine Network for Health and they have enrolled our NP's with CAQH but I don't know what to do after that. I have enrolled each of our NP's with Medicare and MaineCare so they can bill under their own NPI's, but for everyone else they aren't set up or recognized under their own NPI. Do any of you know how it works in Maine with NP's and how I need to make sure they are each set up with each carrier to bill out? I realize we will get reimbursed less, but I don't know anything about the process and want to have an understanding of it.
Thanks in advance for any advice.

Devon

 

[Pam Warren]

Hi, Devon. It all depends on how the Nurse Practice Act is written in Maine. Here in NH, Nurse practitioners can practice independently under their own billing/TIN number; and in private practice if they so choose. This means that any insurance company who insures people in NH have to recognize NPs as independent providers and credential them. This is not the case with PAs, who have to bill under a supervising physician.
Check the Maine Nurse Practitioner Association in Augusta and see if you can get information on whether or not they can practice independently within the scope of their license. If not, you'll have to bill under a supervising physician, but if they are able to do so, your payers will have to provide them with billing numbers. Usually your payer provider reps can give you guidance on how to set them up either way.

 

[dcrossman]

Thank you!