PA Prescriber Credentialing and Prescribing

Written by on March 29, 2013 in Practice tips - No comments

Medicaid Changes in NC

The Division of Medical Assistance (DMA) put forth information in their clinical policies that Physician Assistants would be required to enroll with North Carolina Medicaid effective November 1, 2011.  All services rendered by Physician Assistants were to be filed to Medicaid with their NPI as the rendering (or attending) provider.  Physician Assistants would therefore not be allowed to bill “incident to” the physician after December 31, 2011.

WritingPrescriptionWEBImplementation of this rule and credentialing of Physician Assistants in NC has been a topic of debate.  It is the position of the North Carolina Academy of Physician Assistants (NCAPA) and the North Carolina Medical Society (NCMS) that such requirements, when made outside the rulemaking process, are not enforceable. Experts representing NCAPA and NCMS believe that PAs are already enrolled with Medicaid as a rendering provider, however they are not credentialed.   NCAPA, supported by the NC Medical Society, continues discussions with the DMA and the NC Department of Justice to ensure requirements are reflected in agency rules before they are announced and enforced.

Credentialing is not the only confusing issue.  Initially, in its December Medicaid Provider Bulletin, the Division of Medical Assistance (DMA) published the following information regarding prescribers who are not enrolled in Medicaid:

The Affordable Care Act established a new rule that prohibits Medicaid programs from paying for prescriptions written by prescribers who are not enrolled in the Medicaid program. On January 1, 2013, pharmacy
providers will begin to receive a message at point-of-sale for prescriptions written by prescribers not enrolled in the Medicaid program. This message will notify pharmacy providers that pharmacy claims written by non-enrolled prescribers will begin denying on April 1, 2013.

In both the December and February Medicaid Bulletins, DMA announced all Medicaid prescribers must be direct enrolled or their prescriptions would be rejected, effective April 1, 2013.  DMA is under pressure to implement a related federal requirement that all Medicaid prescribers be enrolled by April 1.  The Division of Medical Assistance (DMA) has since changed their ruling.   The Medicaid prescriber enrollment deadline of April 1 has been rescinded.   To date, no new deadline has been established.

The North Carolina Academy of Physician Assistants (NCAPA) continues its discussions with the Division of Medical Assistance (DMA) regarding Medicaid enrollment applications for physician assistants (PAs). Meetings also continue with health policy advisors for the NC House of Representatives. The DMA has not established a new deadline specifically requiring PAs to direct enroll.  Currently, it is NCAPA’s recommendation that PAs begin the enrollment and credentialing process.

Physician Assistants may enroll by completing the Medicaid provider enrollment application on

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 About the Author:
Lisa P. Shock, MHS, PA-C, is a seasoned PA who has worked with clients to expand care teams in both large and small settings. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at

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