Bcbs NC Provider Enrollment and Credentialing

To enroll as a provider with BCBS NC, you'll need to follow their specific steps for credentialing. The process typically starts with submitting an application to the BCBS NC provider enrollment department.

BCBS NC has a list of required documents, including a completed application, proof of licensure, and malpractice insurance verification. These documents are crucial for a smooth enrollment process.

The credentialing process can take several months to complete, so it's essential to plan ahead and submit your application well in advance. This will give you time to address any issues that may arise during the review process.

BCBS NC uses a third-party vendor to manage the credentialing process, which can make it easier to track the status of your application. You can log in to their online portal to view the progress of your enrollment.

The credentialing process is a crucial step in becoming a Blue Cross and Blue Shield of North Carolina (BCBS NC) provider. All providers and facilities in the network need to be recredentialed every three years.

To start the credentialing process, providers must be registered in the CAQH Provider Data Portal, which is used by BCBS NC for initial credentialing and recredentialing. This is a universal credentialing application that improves quality and timeliness in onboarding new providers.

The credentialing process involves several steps, including completing the credentialing process, submitting for enrollment, and completing the contracting step. If a practitioner is being added to an already enrolled and contracted group, they may submit an Enrollment Pending Claims Filing Exception form to facilitate claims payment.

Here's a summary of the credentialing process:

Note that the credentialing process is not delayed, and BCBS NC complies with state regulations on credentialing timelines when the required information is provided.

To apply for credentialing with Blue Cross and Blue Shield of North Carolina, you'll need to complete a few steps. The credentialing process is required for all practitioners of care, ancillary, and facility providers applying for membership in the network.

First, you'll need to get credentialed with the CAQH Provider Data Portal. This is a universal credentialing application that Blue Cross NC will be using for initial credentialing and recredentialing. You can access the CAQH Provider Data Portal online.

You'll also need to complete the W-9 taxpayer ID form and submit it to [email protected]. This is a required step for all providers and facilities joining the network.

The credentialing process typically takes 60 days, so make sure to submit your application well in advance of your effective date. You can find more information on the credentialing process on the Blue Cross NC website.

Here's a summary of the steps you'll need to take:

Note that the credentialing process is not delayed, and Blue Cross NC complies with state regulations on credentialing timelines when the required information is provided.

To be eligible for credentialing with Blue Cross and Blue Shield of North Carolina (Blue Cross NC), you must meet the board certification criteria.

MDs and DOs must be board certified, and if they're board eligible, they can apply for credentialing with the express condition that they become board certified within three years from their initial credentialing date.

If you're a MD/DO with board eligibility in two or more specialties, you can apply for credentialing with Blue Cross NC, but you must become board certified for each specialty within three years of your initial credentialing.

There's a grandfather clause for MDs and DOs who were credentialed with Blue Cross NC on or before April 30, 2023. They're exempt from the board certification requirement, but they can still obtain board certification and update their file if they choose to do so.

If you're a grandfathered MD/DO who later terminates from the Blue Cross NC network and reapply for credentialing, you'll be treated as an initial practitioner and the terms for initial credentialing will apply.

You can also be viewed as meeting the certification requirement if you meet one of the following criteria: being a MD or DO who is board certified in a specialty recognized by the American Board of Medical Specialties (ABMS) or the American Board of Osteopathic Association (AOA), or being a MD or DO who is board certified by the American Board of Foot and Ankle Surgery (ABFAS) or the American Board of Podiatric Medicine (ABPM) or the American Board of Oral and Maxillofacial Surgery (ABOMS).

Here are the specific board certification requirements: