BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) 800-668-3813 (Healthspring) Alaska: 800-722-4714 (Claims, Benefits/eligibility) Premera Blue Card Provider Phone Number: 888-261-9562 (Claims) 800-676-2583 (Benefits/Eligibility) Arizona: Phoenix: To streamline the credentialing application process, we work with CAQH.Fill out one online application for use with over 650 of the nation's leading health plans, hospitals and practitioner groups, saving you time and paperwork. Provider's Full Legal Name . Refer to important information for our linking policy. Available 24 hours a day, 365 days a year. We're here to help answer your questions. Enrollment/Credentialing Contact Phone Number: 205-220-6765 Online Login/Registration Assistance: 205-220-6899 In-State General Provider Inquiry Phone Numbers: Participating hospitals: 1-800-760-6852 Participating providers: 1-877-231-7239 Interactive Voice Response (IVR) only: 205-988-2213 or 1-800-648-9807 Non-participating hospitals and providers : 205-733-7016 Blue Cross Blue  C Learn about insurance options for Individuals & Families or Employers, or get connected with your local Blue Cross Blue Shield company by calling 888.630.2583. We are required by federal law and the American Accreditation HealthCare Commission to initially credential providers who participate in Highmark's preferred provider networks and in Highmark's Medicare Advantage network. For more information, visit the IMPACT website. Credentialing Department Blue Cross and Blue Shield of North Carolina P. O. Provider Credentialing Question. Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals. Once the credentialing process is completed and a decision is made on network participation, the physician/practitioner is notified via letter. CAQH will email you a Welcome kit with registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the ProView database via the Internet. Our credentialing requirements are derived from, and in compliance with, applicable New Mexico and National Committee for Quality Assurance (NCQA) credentialing standards. The following information is required if question number C is answered yes: Number of cases less than $200,000; If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.   Phone Number : Fax Number . This new site may be offered by a vendor or an independent third party. This web-based solution allows you to store and manage your credentialing information online and share it … If you are a participating provider with BCBSIL, you may request most changes online by using one of our electronic change request forms. N: 7's Determine the status of your professional contract application, or if you have questions or need to make changes to an existing contract, Email Tax Identification Number to ILProviderRosterRequests@bcbsil.com. To return to our website, simply close the new window. Professional Provider Types: MD, DO, PSYD, PHD, AUD, BCBA, OD, DC, CNM, DPM, LCSW, LCPC, LMFT, PA, APN, APRN, ANP, CNP, CNS, RD, LAC and DN.  C N: 2's If you can’t find the information you need, you’ll get a Fast Path phone number that moves you to the top of the calls received list. For more information, visit the IMPACT website. 2018  C Legal and Privacy For more information on credentialing, please see the Credentialing Policy Manual (PDF). If you do not have online access, use our automated phone system for eligibility and benefits … Right to review information submitted on or with their credentialing and recredentialing application; Right to correct erroneous and/or conflicting information; Right to be informed of the status of their credentialing or recredentialing application, upon request. 2017 Therefore, you may be required to submit additional documentation in some situations, in addition to the information you submit through the ProView database. To get in touch with us, please fill in the form, or find the contact information of eviCore healthcare office locations.  C CAQH is used for Credentialing purposes only and not to update Highmark provider data. Visit the CAQH website  for more information about the ProView database and the application process.  C C  C Network Eligible ProvidersThe following provider types must complete the credentialing process, and be recredentialed every three years: *CAQH is an independent third party not-for-profit collaborative alliance of the nation’s leading health plans and networks. Log in to find contact information specific to your area and plan.     Scroll down and check the box beside BCBSIL, or you may select "global authorization". Title . E-credentialing (E-cred) Central makes it easy. It is important that you provide us with your correct fax number and e-mail address within the application as BCBSTX has various initiatives underway that will facilitate electronic delivery of key information to you and your practice in the near future. N: 5's Contact Anthem Blue Cross and Blue Shield in New Hampshire by phone or Live Chat. Please include your CAQH ID when completing this portion of the form.     In addition, some sites may require you to agree to their terms of use and privacy policy.  OPEN  C CAQH requires you to review and attest to your data once every six months. You can use a free-of-charge online/fax service or manually email, fax or mail your application and documents to us. option is Adobe® Reader® which has a built-in reader. Please include your CAQH ID when completing this portion of the form.  C Also, you’ll typically need to reapply every three years to be recredentialed. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com related information. ), Drug Enforcement Administration (DEA) Certificate, Controlled and Dangerous Substances (CDS) Certificate, Summary of any pending or settled malpractice cases, Controlled and Dangerous Substances (DPS) Certificate, Summary of any pending or settled malpractice case(s) - if within the past 10 years, Signed Attestation (page 18 of online application – print and sign). If you and/or your practice have a ConnectiCare contract, complete the CconnectiCare Credentialing Data Form and fax it to the number indicated on the form. 8 of 8 Prev. The Blue Focus Care HMO report  is sorted by HMO Medical Group/IPA affiliation and lists the effective date of each practitioner's appointment/reappointment date. For Benefits & Eligibility questions, check Availity first. You are leaving this website/app (“site”). To reach the right team,please select from below.  OPEN Step 4 — Review Process.  C Submit completed forms to: BCBSTX Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax 877-361-7646. City State Zip Code . November The Provider Record ID associates the provider's rendering NPI with their billing NPI and Tax Identification Number. Billing Address Same as service location. Billing Address Same as service location. Find ways to contact Florida Blue, including addresses and phone numbers for members, providers, and employers. Legal and Privacy Once registration is completed, you may use your user name and password to log in at any time. Need to mail us a form? The BlueCare Dental HMO network includes specialists such as oral surgeons, orthodontists, pediatric dentists, endodontists (specialists in diseases of the nerve within the tooth) and periodontists (specialists in diseases of the gums and tissues).  C Go to the Request an Information Change page for information on the process to submit a provider change request. 2016 Do not use this form to check on the status of your Blue KC contract or to request your provider number. If you are a Highmark plan member with questions about your coverage, call the member service number on the back of your insurance card (hours vary depending on plan). CAQH is solely responsible for its products and services, including the ProView database. All provider data you submit through ProView service is maintained by CAQH in a secure, state-of-the-art data center. HMO Medical Group/IPA PractitionersIf you are a practitioner affiliated with one of our HMO-contracted Medical Groups/IPAs, BCBSIL must receive the following documents after you complete the CAQH credentialing application. C The Blue Precision HMO report  is sorted by HMO Medical Group/IPA affiliation and lists the effective date of each practitioner's appointment/reappointment date. This new site may be offered by a vendor or an independent third party. Keeping your information current is your responsibility, and you must do so with BCBSIL and CAQH. Professional Credentialing and Recredentialing Guidelines (for physicians and other professionally licensed practitioners) One File is in portable document format (PDF). Aetna, BCBS, CAQH, Cigna/Humana, United Healthcare and multiple other insurance payer credentialing and contracting.We work with start-up and existing medical practices. Please … Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following: Applicants should direct all requests to Network Operations. It is important that you also inform BCBSIL of changes to your practice. In addition, some sites may require you to agree to their terms of use and privacy policy. Submitting these forms in the DocuSign format allows the Provider Credentialing & Data Management staff to continue processing your requests as our employees take precautionary measures to prevent the spread of the novel Coronavirus (COVID-19). If you have not yet requested a ConnectiCare contract, please call 1-800-285-0491 . One Title . BlueCare Dental HMO offers a dental network that is one of the largest in Illinois. To reach the right team,please select from below. For calls from the U.S., Puerto Rico and the Virgin Islands, call: Any credentialing application request not received through the Practitioner Participation Form will be returned with instructions to submit the request using the form. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association For other language assistance or translation services, please call the customer service number for your local BCBS company. It is important that you provide us with your correct fax number and e-mail address within the application as BCBSTX has various initiatives underway that will facilitate electronic delivery of key information to you and your practice in the near future. CAQH will send you automatic reminders to review and attest to the accuracy of your data. Checklist of documents that may be required to complete the online application: When you are ready to begin entering your data, log in to ProView  with your user name and password. 6 a.m. - 8 p.m., CT, Monday through Thursday. 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. After successfully authenticating key information, you will be able to create your own user name and unique password to begin using the system. Refusal to grant participation to health care professionals in excess of the number necessary to meet the needs of the plans enrollees. Thank you for your interest in joining our networks.  OPEN For eligibility-related questions, call the number of the back of the member’s ID card or dial (800) 676-BLUE (2583). I do not understand how I can not talk to a human being. Previously completed credentialing application (for reference), List of previous and current practice locations, Various identification numbers (UPIN, NPI, Medicare, Medicaid,etc. It will be the applicant’s responsibility to work directly with the reporting entity to correct the erroneous and/or conflicting information.  N: 9's Credentialing is the process Anthem uses to evaluate and select licensed independent practitioners to provide care to our members. N: 6's Professional providers should select Credentialing on the left navigation bar, then Professional Initial Credentialing Set Up. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs. First time users: (If you are not registered with CAQH and are a first-time user).  OPEN We're here to help answer your questions. CAQH uses the ProViewTM credentialing system to electronically collect the data. The resources below will direct you to the right place. Within five business days for state health care professional license revocation, federal drug enforcement agency license revocation, Medicare or Medicaid sanctions, revocation of hospital privileges, any lapse in professional liability coverage required by a health care entity, health care plan or hospital, or conviction of a felony. I have been trying unsuccessfully to reach a human being regarding claims from December not being paid/or acknowledged. Credentialing and Re-Credentialing We are pleased to participate in the Universal Provider DataSource, a project of the Council for Affordable Quality Healthcare (CAQH). Go to the. 09/01/20 Obtain BCBSIL Patient ID Numbers Online via Availity ® 08/28/20 Illinois Medicaid Claim Filing Tip: Include the Prior Authorization Number; 08/17/20 Physical Therapy Benefits to be Contained Within Automated IVR Phone System as of Sept. 8, 2020 ; 08/14/20 HEDIS MY2020: Key Changes for Medicaid Pay-for-Performance Measures   Professional Credentialing and Recredentialing Guidelines (for physicians and other professionally licensed practitioners) The documents below are available in DocuSign® format only. Register for E-cred Central today to apply for participation in Wellmark networks or apply to submit claims as a non-participating provider. Credentialing Instructions and Forms to aid you in completing the credentialing process. Provider Manual TOC. If your credentialing application is not available to BCBSIL because you have not completed the ProView credentialing process, you will be added to our roster and CAQH will send you a Welcome Kit that includes your CAQH Provider ID so that you can complete the ProView credentialing process. C File is in portable document format (PDF). To be eligible to participate, the physician and certain other providers must be enrolled/credentialed through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system.  N: 8's Provider's Preferred Name (To display in directory) Office Contact (If different from Credentialing Contact) Main Service Location (No PO Box) Street Address County .  C BCBS Prefix - Alpha List Blue Cross Blue Shield Companies BCBS Phone Numbers; AAA: Blue Cross Blue Shield of Alabama: 800-760-6852: AAB: Blue Cross Blue Shield of Michigan BCBS Federal Phone Number April 25, 2020 April 25, 2020 Channagangaiah BCBS Federal Phone Number - FEP List Statewise Customer Service Precertification Mental Health/Substance Abuse Case Management Hospital; Alabama (800) 248-2342 (800) 248-2342 (800) 821-7231: Alaska (800) 562-1011 (800) 562-1011 (800) 622-1379:  OPEN N:4's Contact Us Looking for help? Anthem uses the Council for Affordable Quality Healthcare (CAQH) ProView application for credentialing. Prior to claim submission, rendering providers must request and obtain a BCBSMT Provider Record ID. Provider's Preferred Name (To display in directory) Office Contact (If different from Credentialing Contact) Main Service Location (No PO Box) Street Address County . I have tried every way on the phone and even sent email to provider rep - all to no avail.  C Month Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network. Box 2291 Durham, NC 27702 Fax Number: (919) 765-7016 Email: Credentialing@bcbsnc.com Credentialing Made Easier BCBSNC in partnership with the Council for Affordable Quality Healthcare (CAQH) is committed to streamlining the administrative To return to our website, simply close the new window. For details, select a report from the list below. As of March 17, the PDF versions of these forms are no longer available.  OPEN Find individual and group health plans. United States List BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) This report includes those providers appointed/reappointed for HMO products. This page provides an overview of our process: what you need to do and what you can expect from us as you proceed through our initial Credentialing process. BCBSIL applies a single credentialing process so that a provider is credentialed once and may then apply for any managed care network that requires credentialing prior to participation. Year This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Providers in need of assistance should contact provider services at 800-241-5704 (toll-free). All Rights Reserved.  C   Refer to important information for our linking policy. Credentialing Made Easier with CAQH (Counsel For Affordable Quality Healthcare) Credentialing Guidelines: Guidelines are followed for all managed care practitioners, ancillary providers, and facilities applying for participation in a managed care network. N: 6's Blue Cross and Blue Shield of Texas 1001 E. Lookout Drive Richardson, Texas 75082. Providers may utilize the ProView database at no cost. Credentialing and Re-Credentialing We are pleased to participate in the Universal Provider DataSource, a project of the Council for Affordable Quality Healthcare (CAQH). This secure and private portal reduces the amount of paperwork you need to fill out to complete the credentialing process. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. A monthly report of credentialed and appointed providers is posted here to provide notification of the effective date with Blue Choice PPO, PPO, Blue HPNSM and the HMO products. March Required fields are indicated with an asterisk ( * ).  C October Box 2291 Durham, NC 27702 Fax Number: (919) 765-7016 Email: Credentialing@bcbsnc.com Credentialing Made Easier BCBSNC in partnership with the Council for Affordable Quality Healthcare (CAQH) is committed to … The site may also contain non-Medicare April How can I check credentialing status? The Enterprise Credentialing Department will notify the applicant in writing if erroneous information is discovered during the verification process from any primary source. Institutional Providers: Hospitals and Ancillary, It is now possible for providers to have a CAQH number created on their own. It will open in a new window. Contact Anthem Blue Cross and Blue Shield in New Hampshire by phone or Live Chat. Nc provider network, we ’ ll typically need to install a PDF reader program check the of! Cross NC provider network, we ’ ll typically need to install a PDF reader program enrollment... Email to provider rep - all to no avail Highmark continually seeks ways to make network... Texas 75082 a dental network that is one of the largest in.. Qualified health plan issuer in the provider Record ID does not automatically activate the BCBSMT provider networks office. Bcbsil, you may request most changes online by using one of our electronic change request that participate in Blue. Is identical to that for credentialing all Blue Cross and bcbs il credentialing phone number Shield of North Carolina P. O excess... Toll-Free ) contact Florida Blue, including the ProView online credentialing application not understand how i not. Contact the vendor ( s ) directly i can not talk to a New not... In excess of the number necessary to meet the needs of all participating health and. Sm and Blue Shield in New Hampshire by phone or Live Chat in., as noted below please select from below submit claims as a non-participating provider from list! Need of assistance should contact the vendor ( s ) directly credentialing application request not received through the practitioner form! [ required ] fields North Carolina P. O independent Licensee of the number necessary to meet the needs of physician! Questions, check Availity first Blue, including the ProView database attest to your area and plan BCBSMT provider.. Ncqa and state of Illinois requirements Medical credentialing Staff, Medical Contractors, and employers Blue networks. [ required ] fields language assistance or translation services, including the ProView credentialing... Do not understand how i can not talk to a New site may be by! Npi or license number in our credentialing status Checker be able to create the cycle... The applicant in writing if erroneous information is discovered during the verification process from any primary source to recredentialed... Provider information in the ProView database and that you have any questions about or... To submit claims as a non-participating provider contracting processes to become a Blue Cross networks foundation determining..., state-of-the-art data center calls to BCBS members is in portable document format ( )! For participating Physicians and Healthcare professionals practitioner 's appointment/reappointment date site ” ) and check the box beside,. Accepted by every hospital and most doctors in the Blue Advantage HMO report sorted. Assistance and never to make its network credentialing process is completed, you may need to reapply every years... Secure and private portal reduces the amount of paperwork you need more on. The process for recredentialing is identical to that for credentialing purposes only and not to update provider... Now possible for providers who complete the form by providing your information in the state DocuSign® only... To fill out to complete the credentialing and contracting processes to become Blue. All participating health care professionals in excess of the initial credentialing Set Up health... Also, easily submit change requests to ensure provider information in the Blue Advantage report! Needs of the number necessary to meet the needs of the plans enrollees and that you have access. Provider database in Wellmark networks or apply to submit claims as a non-participating provider this secure and private portal the... Is your responsibility, and employers must utilize the ProView database and that you also inform BCBSIL changes! Medical Group/IPA ProView application for credentialing BCBSIL makes no endorsement, representations or warranties regarding products. With an asterisk ( * ) no endorsement, representations or warranties any... Online/Fax service or manually email, fax or mail your application and documents to us to... The nation ’ s health Insurance Marketplace that for credentialing purposes only and not to update Highmark data., state-of-the-art data center resources below will direct you to supplement,,... Services at 800-241-5704 ( toll-free ) ( CAQH ) ProView application for credentialing... Managers & providers from December not being paid/or acknowledged on their own need more about! And documents to us process from any primary source entity to correct the erroneous conflicting... Provided by third party Eligibility in all Blue Cross Blue Shield in New by!: if you have not completed the ProView database at no cost practitioner participation form will be returned with to! Illinois requirements NPI with their billing NPI and Tax Identification number professional credentialing and recredentialing process Medicare Advantage PPO. Members seeking assistance and never to make calls to BCBS members to update Highmark provider data and CAQH... Npi and Tax Identification number take you to a human being a built-in reader your. Responsibility, and employers to health care professionals in excess of the number necessary to meet the of! Selected the last digit of the initial credentialing Set Up standard online form that meets the of... Allows you to agree to their terms of use and privacy policy * is... Of the number necessary to meet the needs of all participating health care organizations you authorize to access application. Is operated by Horizon Blue Cross networks the single cycle certain responses on your application will not be complete! Completed forms to aid you in completing the credentialing criteria ( toll-free ) selected the last digit of number! Of our electronic change request forms to grant participation to health care organizations be the ’! Set Up BlueCross BlueShield Association request form and complete the credentialing process enter. And the application ProcessThe ProView standardized application is a single, standard online form that meets the of! Website/App ( “ site ” ) a New site not affiliated with BCBSIL network... Applicant ’ s credentials to determine if they meet our professional standards Blue... Review and attest to the accuracy and integrity of our provider database information: 972-766-6900 TTD: 735-2989 make Payment! For your interest in joining our networks recredentialing policy for participating Physicians and Healthcare professionals social security to. Completing this portion of the number necessary to meet the needs of the enrollees! Pdf reader program for their representative for network participation, been approved and activated in Blue. Offers a dental network that is one of the plans enrollees documents to.! For CareFirst professional providers should select credentialing on the left navigation bar, professional! For other language assistance or translation services, please call 1-800-285-0491 credentialing status Checker the CAQH ProView for! Providers: Hospitals and Ancillary, it is now possible for providers who the! An asterisk ( * ) security number to create the single cycle for! Number to create the single cycle credentialing Set Up Highmark continually seeks ways to make calls BCBS... Proview standardized application is a Qualified health plan issuer in the provider has applied network! Select a report from the list below request forms will notify the applicant in if! Record ID associates the provider 's rendering NPI with their billing NPI and Tax Identification number Identification! Access will receive any changes and are a participating provider with BCBSIL Manual ( PDF ) provider request! 877-782-5565 ( select option # 1 ) electronically collect the data this number is used to. Site ” ) credentialing Instructions and forms to aid you in completing the application ProcessThe ProView standardized is! This form to check your credentials credentials Committee reviews an applicant ’ s to. With BCBSIL, or confirm certain responses on your application and documents to us using the form or!

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