Skip to main content
Medtransic Logo

Psychiatric nurse practitioners in private practice

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.

(888) 777-0860Book a Free ConsultationSee pricing →
Billing
4-8%
of what we collect for you
Credentialing
$150
per application, per provider
Contract
None
no long-term contract
Tracking
Live
every claim and application in your portal

One Aetna application, two outcomes

Illustrative

PMHNP applies to Aetna in a state that requires collaboration

Physician in network

  • Aetna-participating, board-certified
  • Agreement filed with the state regulator
  • Meets Aetna's criteria

Physician out of network

  • Not Aetna-participating
  • Application does not meet Aetna's criteria
Where the state requires collaboration, Aetna checks that your collaborating physician is in its network.

Where a PMHNP practice loses revenue

Most of these losses come from rules for nurse practitioners, not physicians.

Medicare pays less than the fee schedule

Medicare caps a nurse practitioner at 85% of the physician amount, then pays 80% of the lower of your charge or that cap. If the physician amount were $100 and you charged at least that, it would pay $68.

Charging Medicare patients more than allowed

Nurse practitioners must accept assignment, so you cannot charge Medicare patients more than Medicare permits. One cash price for everyone has to treat Medicare patients separately.

A collaborating physician outside the network

Where the state requires collaboration, Aetna requires an Aetna-participating, board-certified collaborating physician. If the agreement ends, Aetna expects to hear right away.

Staff time billed as your own work

Medicare pays you only for services you personally perform, and supervising staff does not count. Staff services billed incident to your care are paid at 85% of the physician amount.

A lapsed certification breaks enrollment

National certification is a Medicare condition for nurse practitioners. ANCC's PMHNP-BC lasts 5 years, and a lapse means you no longer meet that condition.

Our part and your part

Medtransic runs

  • Insurance checks before each new patient's first visit
  • Claims under your own NPI, or incident to a psychiatrist when conditions are met
  • Payment posting, checked against each payer's nurse practitioner rate
  • Denials, appeals and follow-up on unpaid claims
  • Medicare, Medicaid and commercial credentialing, plus re-credentialing dates
  • Tracking certification renewals and collaboration changes payers must be told about

Your practice keeps

  • Clinical care, notes and prescribing
  • Your collaborating or consulting physician relationship
  • Your DEA registration and state licenses
  • Fees, cash-pay policy and signing payer contracts

Can a PMHNP open a practice without a physician?

It depends on your state, and Medicare adds its own rule on top.

Full practice states

Full practice means evaluating, diagnosing, treating and prescribing under the state board of nursing alone. As of 2025, per AANP, 27 states, the District of Columbia and two U.S. territories had it.

Time in practice first

In 11 of those states, 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.

Medicare still asks for collaboration

Medicare covers your services only when you work in collaboration with a physician, as state law defines it. Where the state has no rule, you document your scope and the physicians you work with outside it.

The physician does not have to be there

Under Medicare, the collaborating physician need not be present when you see patients. They also need not evaluate each patient you see.

Billing incident to a psychiatrist

It applies only when the psychiatrist provided the initial service, stays actively involved and supervises directly. It never applies in a hospital or skilled nursing facility.

Getting a PMHNP credentialed and enrolled

We build the file once and follow each application to an effective date.

Nurse practitioner basics

For anyone first enrolled since January 1, 2003, Medicare requires state authorization, national certification and a master's in nursing or a DNP.

Collaboration agreement, if required

We record your physician, their network status with each payer, and whether the agreement is filed with the state.

DEA registration and training

Prescribing controlled medications needs a DEA registration in each state where you practice, plus DEA's one-time training.

Medicare enrollment in PECOS

You enroll online under the nurse practitioner specialty, and we set your Medicare fees and patient billing to match required assignment.

Re-credentialing on a calendar

We track ANCC renewal every 5 years and CAQH re-attestation every 120 days (180 in Illinois).

What payers ask of psychiatric nurse practitioners

What each payer, and DEA, asks of a psychiatric nurse practitioner.

What payers ask of psychiatric nurse practitioners
Payer or ruleWhat it asksWatch for
MedicarePays up to 85% of the physician amount. Assignment is required.In collaboration, you may perform psychological and neuropsychological tests yourself, as far as state law allows.
AetnaA master's in nursing, board certification and, where the state requires one, an Aetna-participating, board-certified collaborating physician.Report a collaboration change within ten business days. Be available at least 20 hours a week on average.
DEA, telehealth prescribingSchedule II to V after an audio-video visit, no prior in-person visit, through December 31, 2026 (as checked October 4, 2026).Audio-only for certain opioid use disorder medications. The permanent special registration, proposed January 17, 2025, is not final.
Other commercial plansEach publishes its own nurse practitioner criteria.We read each payer's current criteria before we file.

Your client portal, included

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.
See the client portal →
The billing screen in the Medtransic client portal: totals billed, paid, adjusted and outstanding, a twelve-month chart and A/R by age.
The billing screen. Shown with sample data. It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon.

When you may not need us

  • If you will run a cash-pay practice and never take insurance, you do not need a billing company. Credentialing can wait until you join panels.
  • Settle your state's practice requirements, such as a required practice agreement, first. We file what your state and each payer require, but we do not give legal advice on 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. In 11 of those states you first practice under an agreement for a period. 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 consultation before you sign is free.

Keep reading

+ Sources: 13 checked 2026-10-04

Book a free consultation

We look at a sample of your actual claims and show you, line by line, where money is going uncollected. No commitment follows it.

(888) 777-0860Book a Free Consultation
HIPAA Compliant & SecureDedicated Account ManagerNo Long-Term Contract