AHP

Allied Health Professional — a healthcare provider who is not a physician but delivers clinical services, including nurse practitioners, physician assistants, therapists, and other licensed professionals.

Allied health professionals are the non-physician providers who make up a large and growing portion of the healthcare workforce. The category includes nurse practitioners, physician assistants, certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists, psychologists, licensed clinical social workers, physical therapists, occupational therapists, speech-language pathologists, dietitians, optometrists, podiatrists, chiropractors, and many others. From a credentialing perspective, AHPs go through the same general process as physicians but with requirements specific to their license type. An NP's credentialing file includes their graduate nursing education, national certification (AANP or ANCC), state NP license, and in some states a collaborative practice agreement. A physical therapist's file includes their PT degree, state PT license, and any specialty certifications. Payer enrollment for AHPs has expanded significantly. Twenty years ago, many commercial payers only credentialed physicians. Today, most payers credential NPs, PAs, psychologists, and LCSWs as independent network providers. Some payers also credential PTs, OTs, SLPs, and other AHPs. Medicare enrollment for AHPs follows the same CMS-855I process as physicians. However, Medicare reimburses NPs and PAs at 85% of the physician fee schedule when they bill independently under their own NPI. Under incident-to billing arrangements, services can be billed at 100% of the physician rate, but strict supervision requirements apply. The scope of credentialing requirements for AHPs varies by payer and by state. Some payers credential AHPs using the full NCQA credentialing standards. Others use a simplified verification process. Some delegate AHP credentialing to the employing physician or group practice. If you are an AHP, do not assume that your employer handles all your credentialing. Verify that you are individually enrolled with every payer you bill. Check that your taxonomy code correctly reflects your provider type. Make sure your CAQH profile is complete and attested. And understand your state's scope of practice and supervision requirements, because payers will verify these during credentialing.