PMHNP Private Practice Billing and Credentialing

Medtransic handles psychiatric nurse practitioner billing and credentialing for PMHNPs opening or running a private practice. We enroll you with Medicare and commercial payers, file the collaboration details a payer asks for, and bill claims under your own NPI inside SimplePractice, TherapyNotes or the system you already use. Billing is 4-8% of what we collect for you. Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer. There is no long-term contract.

Last reviewed 2026-10-04.

Where a PMHNP practice loses revenue

Most of the money a new PMHNP practice loses comes from rules that apply to nurse practitioners and not to physicians.

  1. Medicare pays less than the fee schedule you looked up

    Medicare caps a nurse practitioner at 85% of the physician fee schedule amount. It then pays 80% of the lower of your charge or that 85% amount. For example, if the physician amount were $100 and you charged at least that, your cap would be $85 and Medicare would pay $68.

  2. Charging Medicare patients more than Medicare allows

    Nurse practitioners must accept assignment with Medicare. You cannot charge a Medicare patient more than the amounts Medicare permits. A practice that sets one cash price for everyone has to handle Medicare patients separately.

  3. A collaborating physician who is not in the network

    Aetna, for example, requires a nurse practitioner specialist's collaborating physician to be an Aetna-participating, board-certified physician when the state requires collaboration. If your physician is not in that network, the application does not meet Aetna's criteria. If the agreement ends, Aetna expects to hear about it right away.

  4. Staff time billed as if you did the work

    Medicare pays you only for services you personally perform. Supervising other staff does not count as performing the service. Staff services can be billed incident to your care, and then Medicare pays 85% of the physician amount.

  5. A lapsed certification that breaks enrollment

    National certification is a Medicare condition for nurse practitioners. ANCC's PMHNP-BC certification lasts 5 years. If it lapses, you no longer meet one of Medicare's qualifications for nurse practitioners.

Our part and your part

What we run

What stays with you

Your EHR shows what you billed. Your portal shows what we are doing about it.

Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.

Did that claim get paid?

Every claim with its stage and amount, the denials we're working, and your receivables by age.

Where is my application with Aetna?

Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.

What do you still need from me?

One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

Can a PMHNP open a practice without a physician?

It depends on your state, and Medicare adds its own rule on top. Here is what we check before we file anything.

Full practice states. AANP defines full practice as nurse practitioners evaluating, diagnosing, treating and prescribing, including controlled substances, under the state board of nursing alone. As of 2025, per AANP, 27 states, the District of Columbia and two U.S. territories had full practice authority, so check AANP's current state map before relying on that count.

Time in practice first. In 11 of those full practice states, AANP notes that new nurse practitioners must first work under a practice agreement for a set period. A PMHNP fresh out of training may not be independent yet, even in a full practice state.

Medicare still asks for collaboration. Medicare covers nurse practitioner services only when you work in collaboration with a physician, as your state law defines it. Where the state has no rule, you document your scope of practice and the physicians you work with on issues outside it.

The physician does not have to be there. Under Medicare, the collaborating physician does not need to be present when you see patients. They also do not need to evaluate each patient you see.

Billing incident to a psychiatrist. If you work in a psychiatrist's practice, your visit can be billed incident to that psychiatrist only when they provided the initial service, stay actively involved and supervise directly. It never applies in a hospital or skilled nursing facility. Our psychiatry page covers the rest of the psychiatric visit billing.

Getting a PMHNP credentialed and enrolled

Payers check the same nurse practitioner basics, then add their own criteria. We build the file once and follow each application to an effective date.

  1. Nurse practitioner basics

    If you first enrolled in Medicare on or after January 1, 2003, Medicare requires state authorization to practice as a nurse practitioner, national certification and a master's in nursing or a DNP. Aetna asks nurse practitioner specialists for a master's in nursing and board certification. We collect proof of each before any application goes out.

  2. Your collaboration agreement, if the state requires one

    We record who your physician is, their network status with each payer and whether the agreement is filed with the state. Aetna requires any state-required collaborative agreement to be filed with the state regulator.

  3. DEA registration and training

    Prescribing controlled medications needs a DEA registration in each state where you practice. DEA also requires a one-time training for registrants, at the first registration or renewal on or after June 27, 2023. You only complete it once.

  4. Medicare enrollment as a nurse practitioner

    You enroll online in PECOS, Medicare's enrollment system, under the nurse practitioner specialty. Assignment is required, so we set your Medicare fees and patient billing to match.

  5. Re-credentialing on a calendar

    ANCC certification renews every 5 years, and you can apply up to 1 year before it expires. Your CAQH profile, which is free for clinicians, needs re-attesting every 120 days (180 in Illinois). We keep both dates in view so a payer never finds a lapsed record first.

Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer. Your client portal shows each application and its stage, the documents we need from you, and your claims; it is included with every client account.

What payers ask of psychiatric nurse practitioners

Medicare

Medicare pays up to 85% of the physician amount, with assignment required. Working in collaboration with a physician, you may also perform psychological and neuropsychological tests yourself, as far as your state law allows.

Aetna

Aetna's criteria for nurse practitioner specialists include a master's in nursing, board certification and, where the state requires one, an Aetna-participating, board-certified collaborating physician. You must report a change in that arrangement within ten business days and be available for appointments at least 20 hours a week on average. Prescribers also need an unrestricted right to prescribe to the full extent of state law.

Controlled medications by telehealth

Through December 31, 2026, the current end date as checked on October 4, 2026, DEA lets you prescribe Schedule II to V medications after an audio-video visit with no prior in-person visit. Audio-only is allowed for certain opioid use disorder medications. DEA's permanent telemedicine special registration was proposed on January 17, 2025 and is not final yet, so watch for it before January 1, 2027.

Other commercial plans

Each commercial plan publishes its own nurse practitioner criteria. We read the current criteria for each payer you want before we file, instead of assuming one plan's rules apply to the next.

When you may not need us

If you plan to run a cash-pay practice and never take insurance, you do not need a billing company. Credentialing can wait until you decide to join panels.

If you have not yet settled your state's practice requirements, such as a required practice agreement, sort that out first. We file what your state and each payer require, but we do not give legal advice on your scope of practice.

Questions PMHNPs ask us before opening a practice

How much does Medicare pay a psychiatric nurse practitioner?

Up to 85% of the physician fee schedule amount. Medicare pays 80% of the lower of your actual charge or that 85% amount, and you must accept assignment.

Do I need a collaborating physician to bill Medicare?

Medicare requires you to work in collaboration with a physician, as your state law defines it. Where the state has no rule, you document your scope and your physician relationships. The physician does not have to be on site.

Which states have full practice authority for nurse practitioners?

As of 2025, per AANP, 27 states, the District of Columbia and two U.S. territories had full practice authority, and 11 of those states require a period of practice under an agreement first. Check AANP's current map before you plan around it.

Can I keep prescribing controlled medications by telehealth in 2027?

The current DEA flexibilities run through December 31, 2026, as checked on October 4, 2026. DEA's permanent special registration rule was proposed in January 2025 and is not final. Watch for DEA's next step before January 1, 2027.

What does Medicare need before it will enroll me?

State authorization to practice as a nurse practitioner, national certification and a master's in nursing or a DNP, for anyone first enrolling since January 1, 2003. You then enroll online in PECOS.

What does Medtransic charge a PMHNP practice?

Billing is 4-8% of collections. Credentialing is $150 per application, per provider. There is no long-term contract, and the revenue audit before you sign is free.

Sources

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