Nurse practitioners can now establish independent practices, and credentialing is essential

Nearly half of U.S. states allow nurse practitioners to operate on their own, and credentialing is a critical component for those looking to establish their own practices. What do nurse practitioners need to know before becoming a standalone provider, and what is the simplest way to gain credentials?

Increased demand for healthcare threatens to outstrip the supply of physicians in the U.S., which has only 2.6 practicing physicians per 1,000 people, compared to 4.3 in Sweden and 3.2 in France. This is driving an unprecedented demand for nurse practitioners (NPs) – with an expected increase of 52% through 2029.

Traditionally, state practice and licensure laws required NPs to have a career-long collaborating or supervising physician to provide patient care. However, nearly half of U.S. states now allow nurse practitioners to operate on their own, allowing them to establish independent practices.

The opportunity to operate independently means NPs need to establish credentials as a standalone provider to be eligible for in-network status and receive physician-level reimbursements. Complying with the Council for Affordable Quality Healthcare’s (CAQH) credentialing requirements can be challenging even for established providers. Creating a new CAQH application is a highly manual, time-consuming task, and the required quarterly updates for re-attestation can be onerous. CAQH requires extensive credentials including education, residency, internships and peer references. To establish these credentials, hours must be spent uploading copies of licensing information, board certifications, DEA registration and insurance certificates.

To help new, independent NPs navigate the challenges of complying with CAQH, TriZetto Provider Solutions (TPS) offers an end-to-end credentialing service that ensures continuous payer follow up and insight into enrollment status.  Our dedicated team takes provider data, reviews it for accuracy, ensures it is current and either initiates the CAQH process or verifies credentials for re-attestation. We understand the nuances associated with NP credentialing and have direct relationships with all of the major payers.

As the ability for NPs to practice independently continues to increase, NPs can play a critical role in providing much need healthcare services. Partnering with a third-party provider to help manage credentialing allows you to do what you do best – manage patient care – by alleviating the burden of credentialing and making sure you never miss quarterly re-attestation deadlines. Call us to learn more.