Credentialing
Nurse Practitioner and PA Credentialing Services
Our nurse practitioner credentialing services enroll NPs, including psychiatric NPs, and physician assistants with commercial plans, Medicare and Florida Medicaid, solo or in groups. Medicare pays NP and PA services at 85% of the physician fee schedule amount when they bill under their own NPI.
The short answer
What do nurse practitioner credentialing services include?
Practice status, then every payer. A Florida APRN is either registered for autonomous practice (at least 3,000 supervised hours in the past 5 years, among other requirements) or works under a protocol. Each NP or PA then enrolls with Medicare, Florida Medicaid (APRNs as provider type 30, PAs as 29) and each plan. The Advixor Group prepares, submits and follows up each application, including Medicare reassignment to your group.
Practice Status
NP credentialing in Florida starts with practice status
Autonomous registration. The Board of Nursing registers an APRN for autonomous practice who has:
- An active, unencumbered Florida APRN license and no discipline in the past 5 years
- At least 3,000 clinical practice hours in the past 5 years under a physician’s supervision
- 3 graduate semester hours in differential diagnosis and 3 in pharmacology, within the past 5 years
- Professional liability coverage of at least $100,000 per claim and $300,000 a year, or a letter of credit
The Board checks applications for completeness within 30 days, requires electronic fingerprinting, and adds the authorization to the license, where you can verify it.
The Board’s rule defines primary care to include behavioral and mental health conditions. An autonomous APRN can’t perform surgery beyond subcutaneous procedures, must give new patients a written disclosure, and renews every two years with 10 extra continuing education hours. In fiscal 2025-26 the Board received 3,622 applications to upgrade to autonomous practice and issued 3,019.
“An advanced practice registered nurse who is registered under this section may: 1. Engage in autonomous practice only in primary care practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule.”
Under a protocol. Every other APRN works under a protocol kept at each practice location. In a group with several supervising physicians, the protocol must be with at least one of them. The physician notifies the Board of Medicine (a DO, the Board of Osteopathic Medicine, under s. 459.025) within 30 days of starting the protocol and within 30 days after ending it, and a primary care physician may supervise off-site APRNs or PAs at no more than four offices beyond their primary location. Protocol APRNs need coverage too: s. 456.048 requires every APRN to carry malpractice insurance or prove financial responsibility, unless exempt. More in NP autonomy in Florida.
Commercial Plans
Insurance credentialing for nurse practitioners: what plans check
- Florida Blue. Every APRN and PA needs a Florida Blue provider number and an NPI registered with Florida Blue. Those contracted individually, or the only participating practitioner under a tax ID, are credentialed, and recredentialed every three years. In a group, the practice answers for each one’s license and supervision.
- Aetna. An NP needs an RN license, at least a master’s in nursing and board certification. Where the state requires a collaborating physician, the agreement must be with an Aetna-participating, board-certified physician for the whole contract, and cover prescribing, hospital admitting backup, 24/7 availability and holding members harmless for collaboration fees.
- Psychiatric NPs. Lucet, Florida Blue’s behavioral network, names a collaborative agreement with an in-network psychiatrist or addiction medicine specialist, or autonomous licensure, and ANCC psychiatric-mental health certification; more on mental health credentialing.
Medicare
Medicare credentialing for nurse practitioners and PAs
NPs and PAs enroll on the CMS-855I and bill under their own NPI.
- Code 50The Medicare specialty for NPs. Common taxonomy codes: 363LF0000X for a family NP, 363LP0808X for a psychiatric NP.
- Code 97The specialty for PAs (taxonomy 363A00000X), who have been able to bill in their own name since January 1, 2022.
- $2,000The maximum civil money penalty per bill for knowingly billing a patient more than the deductible and coinsurance.
Sources CMS taxonomy crosswalk; Claims Processing Manual, ch. 12; Benefit Policy Manual, ch. 15.
- Collaboration and supervision. An NP’s collaboration follows state law, and the collaborating physician doesn’t have to be present or see each patient. A PA’s supervision follows the state’s scope-of-practice rules.
- Assignment. Every claim is on assignment.
- Groups. Reassignment to your group now goes in Section 4F of the CMS-855I, which absorbed the old CMS-855R, and each clinician’s approval letter carries their own PTAN.
Florida Medicaid
Florida Medicaid: the APRN and PA credentialing process
- APRNs enroll as provider type 30 (specialties include 930, nurse practitioner, and 080, family nurse; 076 is for psychiatric-mental health clinical nurse specialists) and PAs as type 29.
- Sole proprietors, alone or in a group, file the Practitioner Collaborative Agreement (AHCA Form 5000-1067); autonomous APRNs don’t.
- A DEA registration certificate is required to prescribe controlled substances.
- AHCA screens both as limited risk, so a site visit isn’t automatic.
Plan networks are a separate step: see Florida’s Medicaid health plans.
Billing Routes
Own NPI or incident-to: the billing choice in nurse practitioner credentialing
| Billing route | Billed under | Conditions |
|---|---|---|
| Medicare, NP or PA bills directly | The NP’s or PA’s own NPI | Assignment; state collaboration or supervision rules |
| Medicare, incident to a physician | The supervising physician | Office setting; the physician started the treatment and stays involved; direct supervision, in the suite or by real-time audio and video (not for 010 or 090 global codes) |
| Medicare, assistant at surgery | The NP or PA | AS modifier on the claim |
| Florida Medicaid, physician in the building | The physician’s Medicaid ID | Physician in the building and able to assist |
| Florida Medicaid, physician not in the building | The APRN’s or PA’s own Medicaid ID | Collaborative agreement on file, unless an autonomous APRN |
Sources CMS Benefit Policy Manual, ch. 15, §60.2, and Claims Processing Manual, ch. 12; 42 CFR 410.26; AHCA 2026 Practitioner Fee Schedule and Provider Enrollment Policy, App. C.
Sources CMS Claims Processing Manual, ch. 12, §§110–120.1; 42 CFR 410.152(b)(4); AHCA 2026 Practitioner Fee Schedule.
Physician Assistants
Credentialing physician assistants in Florida
A Florida physician may supervise no more than 10 PAs at a time and doesn’t have to cosign their charts. Supervision means the physician’s “easy availability or physical presence,” and telecommunication counts. Florida law says PAs “are authorized to bill for and receive direct payment for the services they deliver,” and an in-scope service must be paid whenever it would be covered if a physician performed it.
APRNs and PAs are held to a 7-day supply of Schedule II drugs, except psychiatric medications prescribed by psychiatric nurses; the limits for children are on scope of practice in Florida.
What’s included
What our nurse practitioner credentialing service includes
CAQH and NPI
Register and maintain each NP's and PA's NPI, and keep their CAQH profile ready for re-attestation every 120 days.
Learn moreMedicare enrollment
Prepare and submit each NP's and PA's Medicare enrollment, including reassignment to your group.
Learn moreFlorida Medicaid enrollment
Enroll APRNs and PAs with Florida Medicaid, with the collaborative agreement form when one is required.
Learn morePayer enrollment
Prepare, submit and follow up each commercial plan application, through the participation agreement.
Learn moreRecredentialing
Keep every enrollment current, from plan recredentialing to Florida Medicaid's renewal every 5 years.
Learn moreStart a practice
Put every filing for an NP-owned practice in order, from the entity your attorney forms to licenses and payer enrollment.
Learn moreQuick answers
Nurse practitioner credentialing services: what NPs and practices ask
The process step by step, Medicare's certification rules, a collaborating physician who leaves, the application fee, timelines and opening your own practice. Bring your own case to a consultation.
What is the NP credentialing process, step by step?
What certification does Medicare require of NPs and PAs?
What happens when an NP's collaborating physician leaves?
Do nurse practitioners pay Medicare's application fee?
How long does NP credentialing take?
Can a nurse practitioner open their own practice in Florida?
Talk to an advisor
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Tell us where your practice is today. We will tell you what we would do first.
Official sources
All read October 17–19, 2026.
- CMS: Claims Processing Manual, ch. 12; Benefit Policy Manual, ch. 15; MFT and MHC enrollment FAQs (Q21); taxonomy crosswalk
- 42 CFR 410.26, 410.74, 410.75, 410.152, part 414, subpart B, 424.502 and 424.514
- Florida Statutes s. 458.347, s. 458.348, s. 459.025, s. 464.012, s. 464.0123; Florida Administrative Code, Rule 64B9-4.001
- Florida Board of Nursing: APRN licensure
- AHCA: Provider Enrollment Policy; 2026 Practitioner Fee Schedule
- Florida DOH: MQA Annual Report FY 2025-26, Tables 1 and 5
- Plans: Florida Blue Provider Manual; Aetna participation criteria; Cigna credentialing