Bcbs Contracting Commission Rates and Services

Blue Cross Blue Shield (BCBS) contracting involves setting commission rates and services that determine how much healthcare providers are reimbursed for each service. Commission rates vary by state and provider type.

BCBS contracting commission rates are typically based on a percentage of the total cost of care, with higher rates for more complex services. For instance, a study found that BCBS contracting commission rates ranged from 10% to 30% across different states.

BCBS contracting services may include claims processing, network management, and quality improvement initiatives. These services help ensure that providers are paid accurately and that patients receive high-quality care.

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To get contracted and appointed with BCBS of TX, you can request contracting directly from their page. The BCBS of TX broker contracting is taken care of by BenaVest’s Contracting Team, who will send out all the necessary contracting documents.

You can reach out to BenaVest by emailing [email protected] or calling 1(800) 893-7201 with any broker questions. The Contracting Team will get back to you as soon as possible.

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If you're a new broker looking to get contracted, don't worry if you have questions - BenaVest is there to help guide you through the process.

Here are the contact details to get in touch with BenaVest:

By reaching out to BenaVest, you'll be on your way to getting contracted and appointed with BCBS of TX.

Credentialing and Enrollment is a crucial step in becoming a contracted provider with BCBS. You may not provide services to BCBS members until your contract is fully executed and you are credentialed, if applicable. Credentialing applications, included in the Enrollment Application, are processed within 60 days of receipt.

To enroll a new practitioner with BCBS, you'll need to complete the Application for Practitioner Enrollment, which can be found on the CAQH website. You can also use the CAQH Provider Data Portal for initial credentialing and recredentialing with BCBS.

Some practitioner types, such as Acupuncturists and Audiologists, do not require contract and credentialing. However, if you're a practitioner type that requires credentialing, you'll need to submit a completed, signed, and dated California Participating Practitioner Application, along with other supporting documents identified on the Blue Shield Credentialing Checklist.

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To join the Blue Shield network, you'll need to be affiliated with an Independent Practice Association (IPA) or medical group that is contracted with Blue Shield. Otherwise, you'll need to sign a direct contract with Blue Shield.

You can manage and update your credentialing information on the CAQH website and share it with insurance carriers, including BCBS. The Health Plan response will include current status, date of the next Credentialing Committee meeting, and identify any missing information necessary to complete the file for presentation to the Credentialing Committee.

Here's a list of practitioner types that require credentialing:

Note that some practitioner types do not require contract and credentialing, such as Endodontists and General Dentists. However, if you're a practitioner type that requires credentialing, you'll need to submit a completed, signed, and dated application, along with other supporting documents identified on the Blue Shield Credentialing Checklist.

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To join the Blue Cross NC network or receive payment for services, providers must go through the application and registration process. This process includes credentialing and enrollment.

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You'll need to register your NPI number to submit claims and receive direct payment to your bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered.

Here's a brief overview of the types of providers who need to register:

Make sure to contact Blue Cross NC Provider Service at 800-777-1643, option 6, to continue the enrollment process if you're an out-of-network provider who previously received payment for services.

To apply for the network, providers can follow these steps. There are three main scenarios: providers wanting to join the network, out-of-network providers registering for payment, and current providers needing to recredential.

For providers wanting to join the network, the process involves credentialing and enrollment.

If you're an out-of-network provider registering for payment, you'll need to follow a different set of steps.

Current providers needing to recredential should also follow a specific process.

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To start the application process, you'll need to submit your application and supporting documents. The documents required vary depending on your situation.

For cardiac event monitoring services, you'll need to submit a specific application within the Blue Medicare HMO and Blue Medicare PPO networks only.

Here are the steps to register your NPI type II number for payment:

Here are the specific requirements for registering your NPI type II number:

If you're joining the Blue Cross NC network, you'll need to complete a W-9 taxpayer ID form. Use the instructional guide (PDF) for help.

To submit the form, simply email it to [email protected].

This is a straightforward step, but don't worry if you're not tech-savvy – just make sure you have the correct email address and the form is attached to the email.

By completing this step, you're one step closer to becoming a part of the Blue Cross NC network.

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To begin the credentialing process, you'll need to select your facility type from the list. This will guide you through the specific requirements and documents needed for each type.

Facilities joining our network or out-of-network facilities registering for payment will need to submit a facilities application, which includes credentialing and enrollment.

If you're a pharmacy, you'll need to submit a copy of a North Carolina license and proof of Medicare certification. Additionally, Medicare verification is required if applicable, and non-accredited pharmacies must submit an exemption letter from Medicare.

Here's a summary of the required documents for different facility types:

To establish an Intensive Outpatient Facility, you'll need to submit a completed Application and a General Psychiatric IOP.

You'll also need to provide one of the following accreditation certificates, if applicable: a copy of a North Carolina Business license, Medicare verification, or a General liability malpractice insurance face sheet, which must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate, or a letter attesting to all covered sites.

If you've answered yes to any under section 1.G in the application, you'll need to provide an explanation. Specifically, if question number C is answered yes, you'll need to provide additional information, which includes:

Non-hospital medical detoxification is a type of facility that requires specific accreditation and licensing.

To be accredited, non-hospital medical detox facilities must be recognized by one of the following bodies: Accreditation bodies for the appropriate services

A copy of a NC Department of facility services license is required for this type of facility, specifically a license for Non-hospital Medical Detoxification-Individuals who are Substance Abusers, License .3100.

A general liability insurance face sheet is also required, including current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).

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Joining the Blue Cross network requires following specific steps to contract with Blue Cross NC.

To become a provider, you'll need to learn about the network and contract with Blue Shield of California Promise Health Plan. This involves understanding the plan's mixed-model HMO health plan and how it contracts with individual physicians, independent physician associations, and medical groups.

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Blue Shield Promise's network comprises over 7,000 physicians, 80 hospitals, and hundreds of ancillary medical professionals.

To join the Blue Shield of California provider network, you can get all your applications, request forms, and credentialing information in one place.

To maintain in-network status, providers must meet certain requirements, including having a physical practice location within the Health Plan's geographic service area.

Here are the key requirements for in-network providers:

The Health Plan does not discriminate against providers on the basis of race, color, national origin, sex, age, or disability.

To join a Blue Shield of California network, you'll need to meet specific requirements. You must maintain a physical practice location within the Health Plan's geographic service area.

You'll also need to have accessible locations for members, which may be subject to an office site visit conducted by the Health Plan. Providers offering telehealth services only will not be credentialed or contracted with the Health Plan.

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To join the Blue Shield of California network, you'll need to be affiliated with an Independent Practice Association (IPA) or medical group that is contracted with Blue Shield. Otherwise, you'll need to sign a direct contract with Blue Shield.

Here are the specific requirements for participation in the Blue Shield of California network:

As of November 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has introduced changes to their provider credentialing and enrollment process.

The new process involves using the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal for initial credentialing and recredentialing. This will improve the quality and timeliness of onboarding new providers.

Providers will need to complete the new online Individual Practitioner Enrollment Form for enrolling new practitioners. This form must be submitted 60 days prior to the provider's effective date.

New groups will need to complete the online Provider Group Enrollment Form for enrolling new groups. This form must also be submitted 60 days prior to the provider's effective date.

The CAQH Provider Data Portal will streamline onboarding processes, reducing turnaround times for credentialing and enrollment.

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Termination and Transfer is a significant process in BCBS contracting. Provider removal, termination, or transfer requires careful attention to detail to avoid returned requests.

To initiate the termination or transfer process, find instructions for submission in the relevant documentation. Processing times will vary depending on the specific circumstances.

Essential details to include in the request are outlined in the instructions for submission. This will help ensure that the request is processed efficiently and without delays.

Submission guidelines are available for review to help you navigate the process. By following these guidelines, you can avoid common mistakes that may lead to returned requests.

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Commission rates for BCBS of TX Texas plans can vary from year to year and state by state.

To get the most up-to-date commission numbers, visit our broker commissions pages.

BenaVest pays out top commissions for all carriers, but commission rates are not guaranteed.

To receive direct payment to your bank account through electronic funds transfer (EFT), you'll need to register your NPI number.

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Registration of your NPI number doesn't guarantee direct payment, however.

Facilities need to register their NPI type II number to submit claims and receive direct payment.

To register your NPI type II number, you'll need to provide documentation, including a copy of the CLIA Full (Level 3) certification or registration, if applicable.

Here are the required documents for NPI type II registration:

Texas Commission Rates can vary year by year and state by state.

Commissions for BCBS of TX are not publicly disclosed, and you'll need to visit the broker commissions pages for the most updated numbers.

BCBS contracting involves understanding these commission rates, which can impact your business decisions.

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To join the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network, you'll need to meet their board certification criteria. This means becoming board certified by a recognized medical specialty board within three years of your initial credentialing date.

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MDs and DOs must be board certified or board eligible with a condition to become certified within three years. They will be credentialed in the respective field in which they are board eligible or certified. Board eligibility in two or more specialties allows MDs and DOs to apply for credentialing, but they must become board certified in each specialty within three years.

Some providers may be grandfathered in, meaning they're exempt from the board certification requirement if they were credentialed with Blue Cross NC prior to April 30, 2023. However, if they later terminate from the network and reapply, they'll be treated as an initial practitioner and must meet the initial credentialing terms.

If you're a new provider, you can join the Blue Cross NC network by meeting their board certification criteria. If you don't meet these requirements, you can submit an explanation for consideration by the Blue Cross NC Credentialing Committee.

Here are the board certification requirements in brief:

To get certified, you'll need to join the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network.

Blue Cross NC is a reputable provider that can help you achieve your certification goals.

Effective August 30, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has implemented new board certification criteria for MDs and DOs.

To be eligible for credentialing, MDs and DOs must be board certified by a recognized medical specialty board. This includes the American Board of Medical Specialties (ABMS), American Board of Osteopathic Association (AOA), American Board of Foot and Ankle Surgery (ABFAS), American Board of Podiatric Medicine (ABPM), or American Board of Oral and Maxillofacial Surgery (ABOMS).

MDs and DOs can apply for credentialing with Blue Cross NC even if they are board eligible, but they must become board certified within three years of their initial credentialing date.

MDs and DOs with board eligibility in two or more specialties can also apply for credentialing, but they must become board certified in each specialty within three years of their initial credentialing date.

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If you were already credentialed with Blue Cross NC on April 30, 2023, or prior, you are grandfathered in and do not need to meet the new board certification criteria. However, if you terminate from the network and later reapply, you will be subject to the new criteria.

Here are the board certification requirements in a nutshell: