forms.aanp.orgMSRA Issue Reporting

AANP Home MyAANP Contact Us MSRA provides credentialing guidance, tracks issues, and responds as a unified voice wherever they can make an impact. MSRA does not collectively negotiate reimbursement rates. * Required 1. Full Name * 2. Credentials/Type of Provider * 3. State(s) * 4. Email address * 5. Best Phone Number (For example: 555-555-5555) 6. Best Time to Reach You (For example: 2-4 PM Eastern, M-F) 7. What insurance carrier(s) are you writing about? * 8a. Is this a credentialing/contracting problem? * Yes No Unsure 8b. If you answered yes or unsure to 8a, please provide more information. 9a. Is this a reimbursement issue? * Yes No Unsure 9b. If you answered yes or unsure to 9a, please provide more information. 10a. Do your patients have to pay a higher co-pay to see you? * Yes No Unsure 10b. If you answered yes or unsure to 10a, please provide more information. 11a. Do your patients need a physician referral to see you? * Yes No Unsure 11b. If you answered yes or unsure to 11a, please provide more information. 12a. For Primary Care NPs: Are your patients able to select you as their primary care provider? Yes No Unsure 12b. If you answered no or unsure to 12a, please provide more information. Do you have any supporting documentation? For example: Letters from insurance carriers (Please de-identify the forms before sending.) I don’t have any supporting documentation. I’ll email my document(s) to msra@aanp.org I’ll fax my document(s) to 703.740.2533. I’ll upload my document(s) right now. (Up to 3 files can be uploaded) Not supported. Any additional comments, please enter...