Participation with BCBSWY cannot be dated prior to approval of the credentialing application. All practitioners are expected to respond to the requests in a timely manner. Be free of conviction for any criminal offense punishable as a felony, or engagement in any improper act related to the qualifications, functions or duties of a, Maintain absence of Medicare/Medicaid sanctions, fines, BCBSWY uses CAQH to streamline the credentialing process. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Box 64560 St. Paul, MN 55164-0560. Credentialing policies and procedures have been established in compliance with Nebraska law, and modeled after URAC and NCQA standards. Please read the application thoroughly and complete all sections. When it’s time to be re-credentialed, BCBSWY will send you an email with your CAQH Proview Provider Number. The recredentialing process is initiated by the Blue Cross credentialing department based on the last credentialing or recredentialing approval date. We’re here to help. Home Office4000 House Ave.Cheyenne, WY 82001800-442-2376TDD 800-696-4710. Credentialing is the process by which Blue Cross and Blue Shield of Oklahoma (BCBSOK) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards. When your credentialing application is received by BCBSWY, our credentialing staff will review it for accuracy and completeness. Credentialing is the process by which Blue Cross and Blue Shield of Montana (BCBSMT) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards. Our Provider Relations staff is available to answer questions about the credentialing process. Learn More To review information submitted to support credentialing application, To be informed, upon request, of their credentialing and/or recredentialing application status. Verify eligibility and benefits, submit claims, and more. You will receive the credentialing application from BCBSWY via email. Getting started. The following steps can be used as a guideline: ... CareFirst BlueChoice, Inc. and The Dental Network are independent licensees of the Blue Cross and Blue Shield … Credentialing The CAQH (Coalition for Affordable Quality Healthcare) universal credentialing process ... Anthem Blue Cross and Blue Shield is the trade name of: In Indiana: Anthem Insurance Companies, Inc. The following pages contain some basic guidelines about our credentialing process. Once you have received your ID Number, login to CAQH ProView and follow the prompts to get started. For Institutions/Facilities submit a fully completed, signed application to BCBSWY through DocuSign. Practitioners are recredentialed at least every three years, but may be asked to recredential more frequently. For Blue Cross NC’s latest information on the, Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, Administrative Guidelines - Alphabetical Index, Administrative Guidelines - Categorical Index, Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Provider - Register Now for the Multi-Payer Provider Expo in Charlotte on July 19, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. Blue Cross NC credentials all practitioners of care, ancillary and facility providers applying for membership in the network(s) and re-credentials the applicable contracted practitioner, ancillary and facility providers every three years. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Privacy Policy      In the third year of the credentialing cycle, BCBSWY requests providers complete a re-credentialing application that requires providers to update information and elements that are subject to change and need to be re-verified. corporate confidential and may not be publicly disclosed or used for any other purpose without written consent from Blue Cross and Blue Shield of Kansas, Inc. *An Independent Licensee of the Blue Cross Blue Shield Association. Contact Provider Information and Credentialing at 410-872-3500 or 877-226-9593 for specific information regarding this requirement. Accessibility      Outside the United States. This website does not display all Qualified Health Plans available through Get Covered NJ. Practitioners must submit a completed, signed and dated California Participating Practitioner Application, along with other supporting documents identified on the Blue Shield Credentialing Checklist included with the application. Disponible únicamente en inglés. This program allows you to expedite your credentialing experience to complete the credentialing process with fewer steps. Have the required levels of individual professional liability coverage. Blue KC will make a decision whether to approve or deny a credentialing application within 60 business days of receipt of the completed application. This includes: Institutions: including Hospitals, Hospice and Skilled nursing. Select Blue Cross Blue Shield Global™ or GeoBlue if you have international coverage and need to find care outside the United States. Register or login to CAQH, complete your profile, and grant BCBSWY access. Forgot User ID? To learn more about why contracting with Blue Shield is the right decision for your practice, view these documents. Once a credentialing determination has been made regarding an application submitted by a provider, BCBSWY notifies the provider. This ensures that each network provider is qualified by education, training, licensure and experience to deliver quality health care services to our members. BCBSWY uses CAQH to streamline the credentialing process. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. ¿Necesita su ID de usuario? Complete the credentialing application and attach all required materials. Credentialing Instructions and Forms to aid you in completing the credentialing process, Credentialing Made Easier with CAQH (Counsel For Affordable Quality Healthcare). The Credentialing Delegation Program is an extension of Blue Cross and Blue Shield of Louisiana’s URAC-accredited credentialing program. Our credentialing policies define requirement, the process, credentialing and recredentialing criteria and rights and responsibilities. Fraud and Abuse. Learn about Blue Cross Blue Shield culture, salaries, benefits, work-life balance, management, job security, and more. to complete the application process and grant BCBSWY access. Blue Cross Medicare Advantage (PPO) SM and Blue Cross Medicare Advantage (HMO) SM, ensuring they meet our professional standards. Practitioners of care to credential/re-credential include: Doctor of Medicine (MD), Doctor of Osteopathy (DO), Doctor of Dentistry (DDS) (DMD), Doctor of Podiatry (DPM), Doctor of Optometry (OD), Doctor of Chiropractic (DC), Doctor of Psychology (PhD), Physical Therapists (PT), Occupational Therapists (OT), Nurse Midwives (CNM), Audiologists (MA), Physician’s Assistants (PA), Pastoral Counselors (PC), Licensed Certified Social Worker (LCSW), Certified Nurse Specialist (CNS), Speech and Language Pathologists (SLP), Family Nurse Practitioner (FNP), Certified Substance Abuse Counselor (CSAC) with appropriate licensure, Licensed Marriage and Family Therapist, Licensed Professional Counselors (LPC), Licensed Psychological Associate (LPA), Licensed Dietician Nutritionist (LDN) and Licensed Professional Counselor Associate (LPCA). Blue Cross and Blue Shield of New Mexico (BCBSNM) welcomes you to apply to join our provider networks. We are pleased that you are considering becoming one of our participating providers. Premera Blue Cross Blue Shield of Alaska is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County. You may contact us by email at, Practitioner’s education and professional training history (including Board certification status if applicable), Documentation of current controlled dangerous substance certificates, federal (DEA) and state (if applicable), Professional disciplinary history (this includes, but is not limited to, state boards and Medicare/Medicaid), Any issues that could impede the practitioner’s ability to provide quality health care services, An attestation that the application is complete and accurate, A statement authorizing BCBSWY to collect verifying information (signed and dated by applicant). Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., comply with applicable federal civil rights laws and do not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex. Credentialing Specialist at Blue Cross and Blue Shield of Minnesota. Successful completion of post graduate residency training or specialty board certification, as applicable. A provider is sent a denial notification letter as well as contact information for the BSBSWY staff to address questions. Applicants applying or reapplying for participation or continued participation in Blue Cross and Blue Shield of Illinois (BCBSIL) networks* have the right to review information submitted to support their credentialing application and receive the status of their credentialing or recredentialing applications, upon request. Technical Information      Please see contact us above for details. Leave no gaps in your work history for the most recent five years, or list the reasons for any gaps as appropriate; e.g., leaves of absence, maternity leaves, illness, etc. Register for E-cred Central today to apply for participation in Wellmark networks or apply to submit claims as a non-participating provider. In the United States, Puerto Rico and U.S. Virgin Islands. Applicant may correct such information by submitting written notification to the credentialing department. When it’s time to be re-credentialed, BCBSWY will send you an email with your CAQH Proview Provider Number. ©2020 Horizon Blue Cross Blue Shield of New Jersey Three Penn Plaza East, Newark, New Jersey 07105. Inscribirse ahora! ¿Olvido su contraseña? CAQH Application for Credentialing: Paper application for providers who don't want to file electronically: Image. © 2021 Blue Cross and Blue Shield of North Carolina. The Blue Cross Blue Shield (BCBS) system is made up of 36 independent and locally operated companies. Credentialing Process Overview . Once you have received your ID Number, login to. For Institutions/Facilities contact BCBSWY to request an application, signed application to BCBSWY through DocuSign. The credentialing process needs to be completed by all providers who wish to provide covered health care services to our members and are requesting network participation with BCBSWY. Credentialing Guidelines | Blue Cross Blue Shield of Wyoming Guidelines are followed for all managed care practitioners, ancillary providers, and facilities applying for participation in a managed care network. While the CAQH credentialing data set is substantially complete, BCBSTX may need to supplement, clarify, or confirm certain responses in the application with individual physicians and other health care providers on a case-by-case basis. Inform us of demographic changes whenever your practice information changes. Blue Cross and Blue Shield of Minnesota Credentialing Department R315 P.O. Inver Hills Community College. The following tips will ensure that the application is complete and reduce delays in processing. To ensure Blue Shield receives all current required documentation, agreements submitted prior to or at the same time as the initial credentialing application will be returned. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Advanced Practice Registered Nurse (CNM, CNP, CRNA, CNS), Licensed Independent Certified Social Worker. Effective Oct. 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin using Verifide, a credentialing verification organization, to conduct primary source verification. Notify us of any changes. Register Now, Ancillary and Specialty Benefits for Employees. Read more about credentialing. Credentialing Status Checker. At minimum, BCBSWY conducts re-credentialing of each participating provider at least every three (3) years. To see all available Qualified Health Plan options, go to the New Jersey Health Insurance Marketplace at Get Covered NJ. Blue Cross uses the recredentialing process to re-evaluate each practitioner’s qualifications and performance. Site Map      Ensure that a current copy of your liability insurance is attached to your CAQH profile. If you only authorize specific organizations access to your profile, please add. View profile View profile badges Get a job like Kristen’s. After you submit the Provider Onboarding Form to get credentialed, check the status of your credentialing process by entering your NPI or license number in our Credentialing Status Checker. In Kentucky: Anthem Health Plans of Kentucky, Inc. In addition, the national Blue Cross Blue Shield Association has published the program as an example of a successful credentialing program. 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