Blue Cross Blue Shield Credentialing
There is no single Blue Cross Blue Shield. There are more than 30 independent licensees, and you credential with the one that holds the license where you practice. We identify the correct plan for every location and run the application with that plan.
The application path we run for this payer
- Intake and gap reviewLicenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- Profile setupCAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- Application submissionEvery enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- Follow-up on a fixed cadencePayers are contacted on a schedule. Requests for more information are answered the same business day.
- Approval, contract and handoffEffective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Blue plans are typically the largest commercial payer in their home state, and BlueCard lets you see members from any Blue plan once you are in network locally. That makes the local Blue contract one of the most valuable a practice can hold, and one of the more time consuming to obtain.
ClainetRCM has credentialed providers with Blue plans across the country, from Florida Blue and BCBS of Texas to Independence Blue Cross and Blue Shield of California. Each has its own portal, application and committee cycle, and we know which one applies to you.
Where this usually goes wrong
Applying to the wrong Blue
Providers in border markets sometimes apply to the neighboring state's Blue plan. The application is rejected and months are lost.
Closed panels by specialty
Some Blue plans restrict new participation in specialties they consider saturated. Applying without checking wastes the committee cycle.
Multiple product lines
A Blue plan may require separate credentialing for HMO, PPO, Medicare Advantage and Medicaid products, and the contract may not cover all of them.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- Home plan identification for every practice location
- Plan-specific application through the correct portal (Availity, plan portal or paper where required)
- CAQH ProView attestation and plan authorization
- Product line selection so HMO, PPO and government products are covered
- Credentialing committee and contracting follow-up
- BlueCard eligibility confirmation and provider directory accuracy check
Blue plans in the states where we credential most providers
| Texas | Blue Cross and Blue Shield of Texas (HCSC) |
|---|---|
| Florida | Florida Blue |
| Massachusetts | Blue Cross Blue Shield of Massachusetts |
| Illinois | Blue Cross and Blue Shield of Illinois (HCSC) |
| Pennsylvania | Independence Blue Cross, Highmark and Capital Blue Cross by region |
| Michigan | Blue Cross Blue Shield of Michigan |
| North Carolina | Blue Cross NC |
Anthem and Regence licensee states are covered on their own pages: Anthem credentialing and Regence credentialing.
Questions about Blue Cross Blue Shield
How long does Blue Cross Blue Shield credentialing take?
Most Blue plans complete credentialing in 90 to 120 days from a complete application. Plans with quarterly committee meetings can take longer if the application misses a cycle, which is why we confirm committee dates before filing.
Do I need to credential with every Blue plan?
No. You credential with the Blue plan that holds the license in the state where you practice. Members of other Blue plans are covered through BlueCard, which bills through your home plan.
What is BlueCard?
BlueCard is the program that lets a member of one Blue plan receive in-network care from a provider contracted with another Blue plan. You bill your local Blue plan, which routes the claim to the member's home plan. It requires an active local Blue contract.
Can a Blue plan reject my application?
Yes, usually for network adequacy in your specialty or for credentialing issues such as gaps in work history or malpractice history. We review the file for those issues before submission and prepare explanations where they are needed.