If you are a healthcare professional, hospital, or clinic and wish to join BCBS’ network as an in-network provider, an extensive credentialing process must take place first. DENmaar typically handles this part of the process; step one should include filling out their Provider Onboarding Form.
Obtain an NPI
Before embarking on the process of joining BCBS’s insurance panel, it is vitally important that you obtain an NPI. This unique 10-digit number serves to identify healthcare providers and is similar to a state license – it serves billing purposes for individual providers or organizations and remains unchanged even if their name, taxonomy code, address or license changes. Furthermore, an NPI allows payers to track who their contracts include.
No matter if you work independently or for a medical practice, an NPI is necessary for accessing NPPES website and submitting credentialing applications. To get an NPI, the following information must be submitted in order to obtain one:
Once you have obtained an NPI, the next step should be submitting documents and credentialing with BCBS. This step is essential as it will determine if you can treat patients under BCBS’ network or out-of-network (OON), the latter meaning no payment for services rendered.
Although an NPI may appear simple, it’s actually an intricate system designed to facilitate more sophisticated data exchange. Part of HIPAA legislation, its requirement has become mandatory across many healthcare entities since its introduction. Furthermore, Medicare providers are required to have one.
Registered dietitian nutritionists and practitioners, whether independent contractors or employees of practices, must have an NPI number. Medicare claims require them to also include a unique 10-digit identifier which indicates their taxonomy group as well as any specializations within it.
NPIs are also used in electronic health records of healthcare providers and, depending on their specialty, may be necessary in order to bill Medicaid. Therefore, it is advisable that healthcare providers check with their state or local administration in order to find out whether an NPI is necessary.
Get a signed contract
Attracting Bcbs as an in-network provider is of utmost importance, yet can be time consuming and complicated. Healthcare providers should seek assistance from third-party credentialing service providers like DENmaar to expedite this process and reduce errors.
Since 1945, the Blue Cross and Blue Shield Association (BCBSA) is an association of 35 independently-operated Blue Cross and Blue Shield companies across North America that offer comprehensive health insurance products and services to over 17 million unionized employees, retirees, and their families. It was formed out of necessity during World War II due to a shortage of coverage due to limited unionized workers at that time.
BCBS has recently been the target of two antitrust lawsuits brought by healthcare providers and individuals alleging its licensing model is unlawful and artificially restrains competition. BCBS denies these claims.
Get a CAQH credential
Becoming an in-network provider with BCBS can be a long process that involves several steps. First, register with CAQH (Consolidated Accreditation of Health Providers, or CAHPs for short), which contains credentialing information about health care providers used by health insurers, medical groups and payers to verify credentials. After your CAQH profile has been completed, send it along with any supporting documentation to any insurance companies that want to contract with you.
CAQH credentials are necessary for licensed healthcare practitioners who intend to bill insurance for their services, including physicians, nurse practitioners, physician assistants and therapists. CAQH is a nationally-recognized credentialing system recognized by numerous major US insurers such as Aetna, Blue Cross Blue Shield and Cigna; also used by local and regional health plans as well as managed care organizations.
To create a CAQH account, submit your state medical license, professional licenses, and any additional documentation directly to the Council for Affordable Quality Healthcare (CAQH) using their ProView system online. Once approved, once your account is verified you can share information with insurers such as Excellus BCBS.
Once you have a CAQH account, you can use it to access and update your medical records and information. Public and commercial payers across the country access this database for credentialing, network management and consumer engagement purposes; additionally it’s secured with best-of-breed data protection standards from HITRUST CSF.
Establishing your CAQH profile may take up to two hours; however, ongoing management of it can be completed more efficiently through an attestation process. To reduce time spent creating your profile, prepare all information ahead of time and have all documents at the ready when starting out.
CAQH Credentialing System offers healthcare practitioners a simple solution for expediting credentialing processes with multiple insurers at once. However, healthcare practitioners should keep in mind that not all payers use CAQH; some regional health plans don’t have an agreement with it and must still use their own systems instead.
Get a CAQH ProView account
An essential step towards getting credentialed with Blue Cross and Blue Shield is opening a CAQH ProView account, which is a free online database where healthcare providers can enter and maintain their information, streamlining both credentialing and contracting processes for payers, while healthcare providers themselves can use the CAQH to update credentials as they change. Once their information has been updated it can automatically populate to other portals and software systems saving time, effort, and inquiries from multiple organizations seeking the same data.
Healthcare providers who wish to obtain an account with CAQH must visit its official website and register. Registration requires providing basic information like name, email address and NPI (National Provider Identifier). In addition, healthcare providers will need to answer a series of questions related to education, work history and professional licensing before providing all documentation for review and verification.
Once information has been submitted to CAQH, health care providers will receive an ATTESTATION document signed by a representative from CAQH that verifies its accuracy. Furthermore, payers will use this form to review applications that have been submitted. It is recommended to recertify to your CAQH profile every 120 days to replace expired documents and ensure accuracy.
ATTESTATION must be signed by either the healthcare provider themselves or their representative, and include any changes since previous submission of information to payers, such as relocating or changing physician organizations. By doing this, accurate information will be sent out to payers more quickly; furthermore, credentialing processes will speed up as more qualified providers become available to patients.