Purpose of Credentialing:
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. 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).
Guidelines are followed for all managed care practitioners, ancillary providers, and facilities applying for participation in a managed care network. These guidelines have been adopted by Blue Cross NC and adhere to the guidelines established by the National Committee for Quality Assurance (NCQA) and the North Carolina Department of Insurance (NCDOI). NCQA is responsible for accrediting Managed Care Organizations (MCO's) using specific standards for Credentialing, Quality Management, Utilization Management, Member Rights and Responsibilities, Preventive Health, and Medical Records. The NCDOI is the regulatory body for the state of North Carolina for managed care organizations.
The following rights are for each practitioner applying for credentialing and/or recredentialing with Blue Cross and Blue Shield of North Carolina:
- To review information submitted to support credentialing application
- To correct erroneous information
- To be informed, upon request, of their credentialing and/or recredentialing application status
- To be notified of these rights
Note: Applying for a Blue Cross NC provider number and contracting is a separate process from credentialing. Please see contact us above for details.