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Physician Extender Guidelines

A physician extender is a specially trained, certified and licensed provider who renders medical services within the scope of his/her license. Blue Cross and Blue Shield of Alabama recognizes the following physician extenders as eligible network participants: a certified registered nurse practitioner (CRNP), a certified nurse midwife (CNM), a physician assistant (PA), and a physician assistant/surgical assistant (PA/SA).

Many groups provide coverage for the services of a CRNP, CNM, PA or PA/SA; however, providers are encouraged to verify a patient's eligibility and benefits before rendering services. Members may not be eligible for reimbursement for services provided by a non-participating CRNP, CNM, PA or PA/SA or services may be reimbursed at the out-of-network benefit level.

Blue Cross requires claims to be billed under the name and National Provider Identifier (NPI) of the provider who actually rendered the service and does not recognize "incident to" billing. Under no circumstances should services performed solely by a CRNP, CNM, PA or PA/SA be billed under a physician's name and NPI. However, a physician may bill for these services under his/her name and NPI if the physician also sees and renders services to the patient, reviews the notes of the physician extender, and concurs with the findings.

Eligibility and benefits can be verified through your practice management software system or through ProviderAccess on our website, www.bcbsal.com/providers.