How to become BlueCross BlueShield Provider?

  • Posted On: September 24, 2021

How to become BlueCross BlueShield Provider?

BlueCross BlueShield is a well-known and respected name in the medical insurance sector. If you are a healthcare practitioner, aligning oneself with BCBS by becoming a BlueCross BlueShield Member could help your career. Providers engage into a contractual arrangement to provide healthcare care to BlueCross BlueShield insurance customers. BCBS medical providers must ensure that their office provides 24-hour medical coverage for patients and must follow the requirements of their contract, which often includes keeping licenses and certificates current.

Requirement

Examine the criteria for BlueCross BlueShield providers in your state on the website. Although BlueCross BlueShield retains many of the similar requirements for provider applications from across country, you should be mindful of state-specific regulations when you begin the provider qualifying process. Check to see whether you have an unlimited state license in your field of medicine and if you are board-certified or can become board-certified. You must also have hospital visit permissions at least one hospital in the BCBS network, and you must carry medical liability coverage with a minimum of $1,000,000 per claim and $3,000,000 aggregate.

Complete Application

Individuals and Medical Groups/Clinics may apply to join our networks by completing the online form.

Facility Providers (hospitals, ambulatory surgery centers, or behavioral health facilities only) may apply to join our networks by completing the online Facility Providers (hospitals, ambulatory surgery centers, or behavioral health facilities only) may apply to join our networks by completing the online Facility Providers (hospitals, ambulatory surgery centers, or please send an email to us [email protected].

This form is required to conduct an initial evaluation to determine your eligibility for participation. If you do not meet the eligibility requirements, BCBSIL will send you a notification letter.

Please submit a signed contract

Once your eligibility is established, BCBSIL will send you an email with a contract for membership in the provider networks for which you qualify. Simply complete, sign, and return the contract to BCBSIL. You can email or fax your signed contract; instructions will be included with your contract packet.

If necessary, Get Credentialed

Certain providers who engage in our networks are required to go through the credentialing procedure before they may be accepted. The following sorts of providers must go through the credentialing procedure and be re-credentialed every three years.

MD, DO, PsyD, PHD, AUD, BCBA, OD, DC, CNM, DPM, LCSW, LCPC, LMFT, PA, APN, ANP, CNP, CNS, LAC, DN, and RD are examples of professional providers. Hospitals and Ancillary Providers are examples of institutional providers (such as skilled nursing facilities, home health, home infusion, durable medical equipment suppliers, etc.) Our credentialing requirements are drawn from and in accordance with Illinois and the National Committee for Quality Assurance (NCQA) credentialing standards.

Wait for the final acceptance notification

We will let you know if you are approved into our networks after we receive your signed contract and you complete the credentialing process, if necessary. If you are accepted, you will be sent a welcome letter with your network’s start date.

Use the Case Status Checker to determine the status of your Provider Onboarding Form application. Input the case number from your confirmation email.

Make a connection

Congratulations! We highly encourage you to use all available electronic options once you are a member of our networks to assist assure the timeliness, accuracy, and security of claims-related information. Refer to the Claims and Eligibility section for more information on electronic data interchange (EDI) transactions. Visit the Provider Tools page for more online tools and resources.

Case Checker Status

If you have done a Provider Onboarding Form, you may check the application process in our Case Status Checker by using the case number from your confirmation email.

If you haven’t already, join the Council for Affordable Quality Healthcare, or CAQH. If you already registered with CAQH, ensure that all of your information is valid and up to date, and give BlueCross BlueShield permission to examine your information. According to the BCBS Massachusetts website, BlueCross BlueShield contracts with Healthcare Administrative Solutions to undertake new provider credentialing. Before submitting provider credentials and accompanying documents to BCBS, HCAS sends them to the Council for Affordable Quality Healthcare for verification by the Credentialing Verification Organization.

Print and fill out Parts I and II of the Physician Data Sheet Form, which can be found on the BlueCross BlueShield Medical Professional Provider page. Fill out the W-9 form to be used for tax purposes. Fax these documents to 303-831-5833, BlueCross BlueShield’s provider contracting department. Once your complete application is received, BlueCross BlueShield may take up to 90 days to review it and respond with a decision. Call the credentialing department at 800-516-7587 to inquire about the status of your application.

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