P
1 jul, 2019

New NP/PCP policy

Effective 26 de marzo de 2019, BCBSRI implemented new credentialing requirements for nurse practitioners (NPs) who are also licensed primary care providers (PCPs). NPs may be credentialed by BCBSRI as a PCP with or without a panel.

A NP/PCP without a panel must be licensed by the Rhode Island Department of Health (RIDOH) as a clinical nurse practitioner (CNP) or clinical nurse specialist (CNS) in one of the following specialties:

  • Family/individual across the lifespan
  • Pediatric
  • Adult/gerontology

A NP/PCP with a panel must be licensed by RIDOH as a CNP or CNS in one of the following specialties:

  • Family/individual across the lifespan
  • Pediatric
  • Adult/gerontology

Additionally, a NP/PCP with a panel must either have:

  • Six months of experience working in their area of focus and be a member of a patient-centered medical home (PCMH) or a system of care (SOC) that is recognized by BCBSRI or a Federally Qualified Health Center (FQHC).
  • OR have three years of experience working in a primary care practice.

All new NP/PCP applicants and status change requests will be reviewed by the Credentialing Committee.

If you have any questions regarding the new change, please contact ProviderRelations@bcbsri.org.