Medical Board Rejection Log
Learn from our learnings. See our notes on where we messed up and got corrected by a medical board, state program or otherwise. We’ll keep updating as we go along.
Disclaimer: This is just for educational purposes only. This is purely based on our experience with working with various medical boards to process and correct agreements and interpretations.
State-by-State Healthcare Notes: The Real Nuances
Alabama
Collaboration agreements must be formally approved before you start—don’t assume “in process” is good enough. Multiple forms that must be mailed or put through a strict and outdated system.
Physician can break supervision into hours, but no more than 360 supervision hours per week.
Random Medicaid Issue: Even slight delays in signing supervision logs can trigger audits.
Alaska
Independent practice for NPs is technically allowed but not widely supported by insurers.
Arizona
N/A
Arkansas
Physicians must visit collaborating clinics quarterly in person—telehealth oversight doesn’t count.
Medicaid approvals often stall without site visit documentation, so double-check before submitting.
California
Medi-Cal loves asking for inconsistent forms—what one reviewer accepts, another may reject.
Medi-Cal enrollment requires proof of 2 physical locations. Other options to enroll are contracting directly with health plans.
Colorado
Medicaid requires two addresses on applications: your mailing address and a separate “practice location” (even if they’re the same).
NPs need physician collaboration for prescribing controlled substances, despite otherwise broad practice authority.
Connecticut
Collaboration agreements must include a section for "emergency contact procedures," but no one tells you this until your paperwork gets rejected.
NPs have independent practice after three years of collaborative practice, but you’ll need proof of that collaboration for audits.
Delaware
Medicaid audits look for patient outcomes reporting, which isn’t common elsewhere—collaboration agreements should include language about this.
NPs need to complete a state-specific orientation for prescribing privileges.
Florida
Medicaid paperwork often gets flagged for using incorrect facility designations in telehealth claims—review carefully.
NPs need to opt into the independent practice registry to bill directly without a collaborating physician.
PHMNPs are required to collaborate with a psychiatrist for prescribing Schedule IIs for mental health. If they are prescribing stimulants as general providers (i.e. ADHD) they can collaborate with a non-psychiatrist. VERY CONFUSING.
Georgia
Georgia requires collaborators that have an active practice location.
Collaborations are considered active once submitted to the state board via mail.
Hawaii
PAs must submit practice protocols for each new collaborating physician, even if nothing changes operationally.
Idaho
Medicaid pays for asynchronous telehealth, but only for specific service codes, which aren’t well-documented.
NPs practicing independently still need physician oversight for methadone prescriptions.
Illinois
Medicaid requires collaboration agreements to list specific tasks by name, not general duties.
NPs can practice independently but still face restrictions for Schedule II medications outside specific facilities.
Indiana
PA Agreements must be on a letterhead and include the home address of both the physician and practitioner.
Collaboration agreements need written termination plans—often overlooked.
Iowa
Medicaid will deny claims for any telehealth encounter not clearly marked as synchronous or asynchronous on the patient record.
NPs gain independent practice authority but must formally document when collaboration ends.
Kansas
NPs can’t independently prescribe controlled substances unless they’ve completed a state-approved course that’s easy to miss in initial licensure instructions.
Collaboration agreements must include a mutual termination clause.
Kentucky
Medicaid requires annual collaboration agreement renewals even if the state doesn’t.
NPs gain independent prescribing after four years, but only for non-controlled substances unless explicitly stated in agreements.
Louisiana
Medicaid doesn’t reimburse for NP-provided telehealth unless it’s specifically noted that the patient resides in a rural area, even if services are covered elsewhere.
Collaboration agreements sometimes require notarization, even though it’s not explicitly stated in state guidance - depends on who is reviewing.
There are state forms to submit for LA.
Maine
Telehealth claims require a pre-existing relationship with the patient unless it’s for urgent care—often miscommunicated by payers.
NPs practicing independently must still notify the state Board annually of their practice status.
Maryland
NPs must retain a collaborating physician for prescribing Schedule II drugs even with independent practice status.
Massachusetts
Medicaid requires NPs to include proof of collaborative oversight for any prior practices within the last 24 months, even if no longer applicable.
Telehealth claims for follow-ups must be coded differently than initial consultations.
Nevada
Nevada required the collaboration to be notarized via form.
Big Weird Rule: PAs must be licensed under the same board as their collaborating physician (MD or DO)—they cannot mix and match.
Medicaid requires notarized collaboration agreements, but only when PAs are involved.
New York
Medicaid audits ask for co-signatures on progress notes from collaborating physicians for certain claims—even if the agreement doesn’t require it.
NPs in independent practice still need a collaborating physician to prescribe buprenorphine.
PAs don’t require collaboration but do have a supervision form required to submit to NY.
Oklahoma
DEA Required a physician to oversee NP with prescriptive authority.
Texas
You need proof of submission for every collaboration agreement—screenshot or certify it via your TMB portal; the practitioner requests first, then the physician confirms.
Medicaid often denies claims for missing supervising physician contact details in patient records.
DEA Required
