Private Payers

Nearly all private payers reimburse for services provided by PAs; however, insurers may have different policies regarding how PAs are credentialed, what services PAs may provide, and how services provided by PAs should be billed. In general, when state laws are followed, insurance plans cover PAs providing medically necessary services that are within the scope of PA practice. Many payers request that PAs submit claims for medical services under the physician’s name and provider number and reimburse for the PA’s services at the same rate a physician would receive. Some payers, however, individually credential PAs and ask that claims be submitted with the PA’s name. It is imperative that the practice employing the PA ascertain the payment policies for each payer with whom they contract.

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