Join Our Provider
Network or Recredential

Join the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) provider network or recredential today.


Choose the process you'd like to start: 

Becoming an in-network Blue Cross NC provider is a simple three-part process. 

  1. Get credentialed or recredentialed
  2. Register your National Provider Identifier (NPI) with us
  3. Have a signed contract

Existing providers will need to be recredentialed every three years with Blue Cross NC. 

Network Exceptions:

  • Optometry and Ophthalmology commercial networks are closed in all counties. Optometrist and ophthalmologist participation for routine vision is managed by Community Eye Care (CEC). Contact CEC for participation inquiries and to initiate credentialing and/or recredentialing by email at providers@cecvision.com and by phone. (CEC 888-254-4290)
  • Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.

Credentialing/Recredentialing Updates:

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. Here’s what this means for you:

  • Verifide uses the CAQH ProView credentialing database as part of their verification process. Therefore, all providers applying for Blue Cross NC credentialing and recredentialing must be registered in CAQH ProView.
    • If you are not registered for CAQH ProView and are seeking credentialing/recredentialing, please visit https://proview.caqh.org and click "register now" in option 3 under the "FIRST TIME HERE?" section. If you have trouble registering, contact CAQH ProView at: 1-888-599-1771, M-F 7 a.m. – 8 p.m. (EST) or use the chat portal on the website. You also should complete your profile and attestation once you're registered.
    • If you are already registered for CAQH ProView, you do not need to take any action. Verifide will contact you if they need additional or updated information for primary source verification. Additionally, you should continue your usual process of attesting every 120 days that your information is accurate in the CAQH ProView database.
  • Recredentialing will be delayed until provider information is complete and updated in the CAQH ProView database.

If you have questions, contact Provider Services at 1-800-777-1643 option 6.

 

Additional Information

Guidelines

Blue Cross NC follows the rules set up 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 set 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.

Practitioner Rights

Each provider applying for credentialing and/or recredentialing with Blue Cross NC has the right to:

  • Fix any errors
  • Review information sent to support credentialing application
  • Ask for information about credentialing and/or recredentialing application status
  • Be informed of these rights

You don't need to be credentialed to register your NPI number. But we suggest you complete both steps at the same time.

Are you interested in being an out-of-network provider? You only need to register your NPI number. 

Out-of-Network Provider NPI Registration

Use these forms to register your NPI number and Tax ID with Blue Cross NC. We've also included instructions to help you complete the forms if you need additional help.


For Individual Providers 

For Group Providers

Email us your enrollment application and Taxpayer ID form:

ProvRequests@bcbsnc.com

Fax
919-765-4349

Mailing address
Blue Cross and Blue Shield of North Carolina
Attention: PrIMO
P.O. Box 2291
Durham, NC 27702-2291


 

Apply for Credentialing or Recredentialing

All providers in the Blue Cross NC network need to be recredentialed every three years. You can use the online application process to send your application documents to us. 

Who's required to be credentialed/recredentialed?

Providers

Board Certified & Non-Board Certified:
  • Doctor of Dental Surgery
  • Doctor of Maxillofacial Surgery
  • Doctor of Medical Dentistry
  • Doctor of Osteopathy
  • Doctor of Podiatry
  • Medical Doctor

Other:

  • Advanced Practice Nurse
  • Audiologist
  • Certified Substance Abuse Counselor
  • Chiropractor
  • Doctor of Dental Science
  • Doctor of Optometry
  • Hearing Aid Fitter
  • Licensed Certified Social Worker
  • Licensed Clinical Addiction Specialist
  • Licensed Clinical Social Worker Associate
  • Licensed Dietitian Nutritionist
  • Licensed Marriage and Family Therapist
  • Licensed Marriage and Family Therapist Associates
  • Licensed Pastoral Counselor
  • Licensed Professional Counselor
  • Licensed Professional Counselor Associate
  • Licensed Psychological Associate
  • Occupational Therapist
  • Pharmacist
  • Physical Therapist
  • Physician Assistant
  • Psychiatric Nurse
  • Psychologist
  • Respiratory Therapist
  • Speech Pathologist

Facilities

  • Ambulance
  • Ambulatory Surgical Center
  • Birthing Center
  • Independent Diagnostic Testing Facility
  • Dialysis Facility
  • Durable Medical Equipment (Diabetic Supplies Only)
  • Free Standing Radiology
  • Home Durable Medical Equipment
  • Home Health Agency
  • Home Infusion Therapy
  • Hospice Agency
  • Hospital
  • Intensive Outpatient Facility
  • Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)
  • Opioid Treatment Centers
  • Orthotics and Prosthetics
  • Partial Hospitalization
  • Private Duty Nursing
  • Reference Laboratory
  • Residential Treatment Facility
  • Skilled Nursing Facility
  • Sleep Center
  • Specialty Pharmacy

Begin the credentialing/recredentialing process.

Fields marked with an asterisk (*) are required.


Facilities must manually submit their credentialing/recredentialing application

You have three options to manually supply Blue Cross NC with your application - email, fax, or mail. 

Start the Manual Application Process


Where to send your application once it's complete:

Email: 

credentialing@bcbsnc.com

Fax:

(919) 765-7016

Mailing address:

Blue Cross and Blue Shield of North Carolina

Attention: Credentialing Department

P. O. Box 2291

Durham, NC 27702


Providers can submit their application online via CAQH ProView

Blue Cross NC is working with the Council for Affordable Quality Healthcare (CAQH) to make the application process easier. This means you don't need to fill out and send multiple applications. 

We speed up the credentialing process so you spend less time with paperwork and more time with your patients. 

By applying online:

  • You can submit your information online easily
  • You can change your information yourself to make sure it's up-to-date
  • We can access your information whenever you've given us approval
  • We can verify and review your credentials to make sure they meet Blue Cross NC requirements
  • Your information is stored securely and you can access it whenever you want on your schedule
Please follow these steps: 
  1. Make sure you are a CAQH member and get a CAQH provider number (only for providers who aren't already registered with CAQH)
  2. Apply for credentialing/recredentialing using the button below
  3. Return here and email us at credentialing@bcbsnc.com to let us know you've completed your online application and we can start our review process
  4. Make sure your application status show the "Completed" stage before emailing us

Start the CAQH ProView Application Process

Need more information?

To learn more about CAQH and the CAQH UCD, you can visit their website to watch an online demonstration. Or read our frequently asked questions for more information. 


 

Once you have completed your CAQH application process, please email us to let us know to begin processing your application. 

Your application must be in the "Completed" status before we can begin processing. Please ensure it's in the correct status. 

Send Us an Email

Please follow the steps above until you have a received a "Completed" status from CAQH and email us at credentialing@bcbsnc.com to let us know you have completed your application.

Join our Provider Network

Who's required to be credentialed/recredentialed?

Providers

Board Certified & Non-Board Certified:
  • Doctor of Dental Surgery
  • Doctor of Maxillofacial Surgery
  • Doctor of Medical Dentistry
  • Doctor of Osteopathy
  • Doctor of Podiatry
  • Medical Doctor

Other:

  • Advanced Practice Nurse
  • Audiologist
  • Certified Substance Abuse Counselor
  • Chiropractor
  • Doctor of Dental Science
  • Doctor of Optometry
  • Hearing Aid Fitter
  • Licensed Certified Social Worker
  • Licensed Clinical Addiction Specialist
  • Licensed Clinical Social Worker Associate
  • Licensed Dietitian Nutritionist
  • Licensed Marriage and Family Therapist
  • Licensed Marriage and Family Therapist Associates
  • Licensed Pastoral Counselor
  • Licensed Professional Counselor
  • Licensed Professional Counselor Associate
  • Licensed Psychological Associate
  • Occupational Therapist
  • Pharmacist
  • Physical Therapist
  • Physician Assistant
  • Psychiatric Nurse
  • Psychologist
  • Respiratory Therapist
  • Speech Pathologist

Facilities

  • Ambulance
  • Ambulatory Surgical Center
  • Birthing Center
  • Independent Diagnostic Testing Facility
  • Dialysis Facility
  • Durable Medical Equipment (Diabetic Supplies Only)
  • Free Standing Radiology
  • Home Durable Medical Equipment
  • Home Health Agency
  • Home Infusion Therapy
  • Hospice Agency
  • Hospital
  • Intensive Outpatient Facility
  • Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)
  • Opioid Treatment Centers
  • Orthotics and Prosthetics
  • Partial Hospitalization
  • Private Duty Nursing
  • Reference Laboratory
  • Residential Treatment Facility
  • Skilled Nursing Facility
  • Sleep Center
  • Specialty Pharmacy

Begin your application to join our provider network.

Fields marked with an asterisk (*) are required.


Step 1: Facilities must manually submit their credentialing/recredentialing application

You have three options to manually supply Blue Cross NC with your application - email, fax, or mail. 

Start the Manual Application Process


Where to send your application once it's complete:

Email: 

credentialing@bcbsnc.com

Fax:

(919) 765-7016

Mailing address:

Blue Cross and Blue Shield of North Carolina

Attention: Credentialing Department

P. O. Box 2291

Durham, NC 27702


Step 1: Providers can submit their application online via CAQH ProView

Blue Cross NC is working with the Council for Affordable Quality Healthcare (CAQH) to make the application process easier. This means you don't need to fill out and send multiple applications. 

We speed up the credentialing process so you spend less time with paperwork and more time with your patients. 

By applying online:

  • You can submit your information online easily
  • You can change your information yourself to make sure it's up-to-date
  • We can access your information whenever you've given us approval
  • We can verify and review your credentials to make sure they meet Blue Cross NC requirements
  • Your information is stored securely and you can access it whenever you want on your schedule
Please follow these steps: 
  1. Make sure you are a CAQH member and get a CAQH provider number (only for providers who aren't already registered with CAQH)
  2. Apply for credentialing/recredentialing using the button below
  3. Return here and email us at credentialing@bcbsnc.com to let us know you've completed your online application and we can start our review process
  4. Make sure your application status show the "Completed" stage before emailing us

Start the CAQH ProView Application Process

Need more information?

To learn more about CAQH and the CAQH UCD, you can visit their website to watch an online demonstration. Or read our frequently asked questions for more information. 


 

Once you have completed your CAQH application process, please email us to let us know to begin processing your application. 

Your application must be in the "Completed" status before we can begin processing. Please ensure it is in the correct status. 

Send Us an Email

Please follow the steps above until you have a received a "Completed" status from CAQH and email us at credentialing@bcbsnc.com to let us know you have completed your application.

 


Step 2: Register Your NPI Number

Providers need a registered NPI number to be able to submit claims and receive direct payment.

However, registration of your NPI does not guarantee direct payment. Only providers with a Blue Cross NC contract can receive direct payment. Choose "Participation Contract Request" at the top of the enrollment forms to become a contracted provider. 


If you have a registered NPI number with us, you've already completed the credentialing process, or are requesting an in-network contract, please call the Blue Cross NC Provider Service at 1-800-777-1643, choose option 6 and then initiate your request. 


 


Use these forms to register your NPI number and Tax ID with Blue Cross NC. We've also included instructions to help you complete the forms if you need additional help.


Send us your enrollment application and Taxpayer ID form:

Email

providerupdates@BCBSNC.com

Fax

919-765-4349

Mailing address

Blue Cross and Blue Shield of North Carolina

Attention: PrIMO

P.O. Box 2291

Durham, NC 27702-2291


Once you have sent us your enrollment forms, please move to step 3 below.


Use these forms to register your NPI number and Tax ID with Blue Cross NC. We've also included instructions to help you complete the forms if you need additional help.


Send us your enrollment application and Taxpayer ID form:

Email

providerupdates@BCBSNC.com

Fax

919-765-4349

Mailing address

Blue Cross and Blue Shield of North Carolina

Attention: PrIMO

P.O. Box 2291

Durham, NC 27702-2291


Once you have sent us your enrollment forms, please move to step 3 below.

 


Step 2: Register Your NPI Number

Providers need a registered NPI number to be able to submit claims and receive direct payment.

However, registration of your NPI does not guarantee direct payment. Only providers with a Blue Cross NC contract can receive direct payment. Choose "Participation Contract Request" at the top of the enrollment forms to become a contracted provider. 


Use these forms to register your NPI number and Tax ID with Blue Cross NC. We've also included instructions to help you complete the forms if you need additional help.



Send us your enrollment application and Taxpayer ID form:

Email

providerupdates@BCBSNC.com

Fax

919-765-4349

Mailing address

Blue Cross and Blue Shield of North Carolina

Attention: PrIMO

P.O. Box 2291

Durham, NC 27702-2291


Once you have sent us your enrollment forms, please move to step 3 below.


Use these forms to register your NPI number and Tax ID with Blue Cross NC. We've also included instructions to help you complete the forms if you need additional help.


Send us your enrollment application and Taxpayer ID form:

Email

providerupdates@BCBSNC.com

Fax

919-765-4349

Mailing address

Blue Cross and Blue Shield of North Carolina

Attention: PrIMO

P.O. Box 2291

Durham, NC 27702-2291


Once you have sent us your enrollment forms, please move to step 3 below.


If you have a registered NPI number with us, you've already completed the credentialing process, or are requesting an in-network contract, please call the Blue Cross NC Provider Service at 1-800-777-1643, choose option 6 and then initiate your request. 


 

 


Step 3: Get a signed Blue Cross NC contract

The contract process takes 30 days from the date you register your NPI number. You should follow the steps below while you are waiting to ensure your application can be processed. 

If you haven't heard from us after 30 calendar days, call Blue Cross NC at 1-800-777-1643 and choose option 6 to check the status of your application.

Before we can process your contract application, you should:

  1. Get credentialed or recredentialed
  2. Register your NPI number
  3. Register for Blue e to be able to access important provider documents
  4. Sign up for EFT to receive claims payments

Blue e Billing Service Exception

  • Billing Services:  Signing Up for Blue e for BILLING SERVICES.
    If you represent a billing service, please complete the Blue e Network Agreement for Billing Services. Forms available online (https://www.bluecrossnc.com/providers/providers-forms-and-documentation).  Print the form after completing and fax this agreement to Blue Cross NC.

  • IMPORTANT NOTE: An authorization letter from each provider, on the provider letterhead, must be received with this application in order to verify you have permission to perform business functions on their behalf. Blue Cross NC will process only those NPI for which an authorization letter is submitted.


 

 


Step 3: Get a signed Blue Cross NC contract

The contract process takes 30 days from the date you register your NPI number. You should follow the steps below while you are waiting to ensure your application can be processed. 

If you haven't heard from us after 30 calendar days, call Blue Cross NC at 1-800-777-1643 and choose option 6 to check the status of your application.

Before we can process your contract application, you should:

  1. Get credentialed or recredentialed
  2. Register your NPI number
  3. Register for Blue e to be able to access important provider documents
  4. Sign up for EFT to receive claims payments

Blue e Billing Service Exception

  • Billing Services:  Signing Up for Blue e for BILLING SERVICES.
    If you represent a billing service, please complete the Blue e Network Agreement for Billing Services. Forms available online (https://www.bluecrossnc.com/providers/providers-forms-and-documentation).  Print the form after completing and fax this agreement to Blue Cross NC.

  • IMPORTANT NOTE: An authorization letter from each provider, on the provider letterhead, must be received with this application in order to verify you have permission to perform business functions on their behalf. Blue Cross NC will process only those NPI for which an authorization letter is submitted.


 


Thank you for applying to join the Blue Cross NC network! A representative will reach out to you soon about your application.

Please allow at least 60 days for your application to be processed by us. This process could take longer if there is incomplete or inaccurate information in your application. 

If after 60 days you have not heard anything back from us, you can call us at 1-800-777-1643 (option 6) to speak to an individual for:  

  • ​Status Inquiries  
  • Credentialing/Recredentialing Inquiries  
  • Enrollment Questions  
  • Contracting Questions 

Thank you for applying to join the Blue Cross NC network! A representative will reach out to you soon about your application.

Please allow at least 60 days for your application to be processed by us. This process could take longer if there is incomplete or inaccurate information in your application. 

If after 60 days you have not heard anything back from us, you can call us at 1-800-777-1643 (option 6) to speak to an individual for:  

  • ​Status Inquiries  
  • Credentialing/Recredentialing Inquiries  
  • Enrollment Questions  
  • Contracting Questions