Understanding Anthem BCBS Provider Enrollment and Credentialing

To enroll as a provider with Anthem BCBS, you'll need to go through their credentialing process, which involves verifying your qualifications and experience. This typically takes 30-60 days.

Anthem BCBS requires providers to have an active National Provider Identifier (NPI) number to enroll in their network. This number is used to identify healthcare providers and is a requirement for all healthcare providers.

As part of the enrollment process, you'll need to submit an application, which includes providing your NPI number, as well as other required documentation, such as your medical license and malpractice insurance information.

To become an Anthem BCBS provider, you can start the process with their support. They'll guide you through the steps to join their network.

First, you'll need to partner with Bikham Healthcare, which provides a range of services to help you through the process. This is a crucial step in becoming a provider with Anthem BCBS.

To begin the enrollment process, you'll need to submit a provider application, which includes credentialing and enrollment. This is the same process for both new and existing providers.

Here are the steps to follow for a provider application:

In addition to provider applications, facilities also need to go through an enrollment process. This involves submitting a facilities application, which includes credentialing and enrollment.

The enrollment process can be a bit overwhelming, but don't worry, I've got the lowdown.

To start, you'll need to register with CAQH, which is a secure and private website where you can manage your credentialing information. You can self-register by visiting proview.caqh.org.

If you're already registered with CAQH, you'll need to give Anthem permission to access your credentialing information, which is a crucial step in the process.

The credentialing process typically takes 45 days from the time the credentialing department receives your completed CAQH application, so be sure to plan ahead.

You'll need to provide a complete application, which includes your signature and application date, CAQH status, current license to practice, education/training, and current DEA or CDS certificate.

Here's a breakdown of the requirements:

Once you've completed your application, you can submit it to Anthem, and they'll review it to ensure you meet their credentialing requirements.

If you have any questions or need assistance, you can review the New Provider Quick Reference Guide or call the CAQH Provider help line at 888-599-1771.

As you go through the enrollment process, it's essential to know your rights as a provider. You have the right to review information submitted to support your credentialing application.

Providers have several rights that are designed to ensure transparency and fairness throughout the process. You have the right to correct erroneous information that may have been submitted.

Here are some specific rights you have as a provider:

These rights are in place to protect you and ensure that your application is processed fairly and accurately.

Before you can start providing care to Anthem BCBS members, you need to go through the provider enrollment process.

You can begin by checking if your practice is already contracted with Anthem BCBS. To do this, visit the Anthem BCBS website and use their provider lookup tool.

You'll need to have your National Provider Identifier (NPI) and Taxpayer Identification Number (TIN) handy to search for your practice.

Once you've verified your practice is contracted, you can start the enrollment process by submitting an enrollment application to Anthem BCBS.

This application will require you to provide detailed information about your practice, including your address, phone number, and specialties offered.

To become an Anthem BCBS provider, you'll need to complete a provider application, which involves credentialing and enrollment. This process includes providers wanting to join the network, out-of-network providers registering for payment, and current providers needing to recredential.

You'll need to complete and email a W-9 taxpayer ID form to Blue Cross NC. This form is required for providers joining the network and can be found in an instructional guide on the Blue Cross NC website.

To streamline the process, you can refer to the following steps for provider application:

Facilities will need to complete a facilities application, which also involves credentialing and enrollment. This process includes facilities joining the network, out-of-network facilities registering for payment, and facilities recredentialing.

If you're a facility or provider, you can refer to the following steps for facilities application:

Recredentialing is an essential part of maintaining your Anthem BCBS provider enrollment. You'll need to recredential every three years to continue participating in the network.

Anthem recredentials network providers every three years, so be sure to stay on top of this deadline. If your CAQH application is current and complete at the time of recredentialing, you might not need to take any further action.

If CAQH is expired or missing information, Anthem will contact you to update the details. This is a crucial step to avoid administrative termination from the network.

Non-response to recredentialing requests can lead to termination, so it's essential to stay proactive. If you don't update CAQH or provide the required information by the due date, your application will be considered incomplete.

To ensure a smooth recredentialing process, keep your CAQH application up-to-date and complete. This will save you from potential issues down the line.

Blue Cross NC and Blue Cross and Blue Shield of North Carolina (Blue Cross NC) also require recredentialing every three years for all practitioners, ancillary, and facility providers. This applies to all providers and facilities in their networks.

Here's a quick rundown of the recredentialing requirements for Blue Cross NC and Blue Cross and Blue Shield of North Carolina:

Credentialing with Anthem is a straightforward process that can be completed through the Council for Affordable Quality Healthcare (CAQH) ProView application.

This secure and private website reduces the paperwork needed to complete the credentialing process.

Anthem uses this application to evaluate and select licensed independent practitioners to provide care to their members.