Are you new to Blue Cross NC or an existing contracted provider who needs to be credentialed or recredentialed?
You're in the right place! This page has all the details you need to complete the full contracting or credentialing / recredentialing process.
Please Note the following Network Exceptions:
- Physical Therapy professional commercial networks are closed to new providers in select counties. (See the list of closed counties.)
- 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 firstname.lastname@example.org 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.
Update on Credentialing and Recredentialing Process
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.
Becoming an in-network Blue Cross Blue Shield of North Carolina (Blue Cross NC) provider is a three-part process.
- Before you start, please check Network Exceptions (see above)
- Part 1: Get credentialed or recredentialed
- Part 2: Register your National Provider Identifier (NPI) with Blue Cross NC
- Part 3: Have a signed contract with Blue Cross NC
You don’t need to be credentialed to register your NPI number. We suggest you complete the two parts at the same time. If you’d like to be an out-of-network provider, you’ll only need to complete part 2 to register your NPI number. Go to Part 2.
Part 1. Apply for Credentialing or Recredentialing
To join the Blue Cross NC provider network, we’ll need to check your credentials. You can use a free-of-charge online/fax service or manually email, fax or mail your application and documents to us. Also, you’ll typically need to reapply every three years to be recredentialed.
If you only need to be recredentialed, you’ll only need to complete Part 1.
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.
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
Who's required to be credentialed/recredentialed?
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
- Advanced Practice Nurse
- Certified Substance Abuse Counselor
- 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
- Physical Therapist
- Physician Assistant
- Psychiatric Nurse
- Respiratory Therapist
- Speech Pathologist
- 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
- Intensive Outpatient Facility
- Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)
- Opioid Treatment Centers (Blue Medicare Only)
- Orthotics and Prosthetics
- Private Duty Nursing
- Reference Laboratory
- Residential Treatment Facility
- Skilled Nursing Facility
- Sleep Center
- Specialty Pharmacy
Option 1: Submit Your Application Online (Providers only)
You can send the Uniform Application to a single database called the Universal Credentialing DataSource® (UCD ). Blue Cross NC has been working with the CAQH (Council for Affordable Quality Healthcare) to help make the process simpler so you don’t need to fill out and send multiple credentialing/recredentialing applications. This free online service helps you speed up the credentialing process so you can spend more time caring for your patients. At this time this service is only available to providers. Facilities will need to manually send their application (see Option 2 below).
- You can submit your information online, email or by fax free-of-charge.
- You can change your information yourself to make sure it's accurate and up-to-date (you’ll need to do this every 3 years).
- Blue Cross NC can access your information anytime (only with your approval).
- Blue Cross NC can continue to verify and review your credentials to make sure they meet Blue Cross NC requirements.
- Your information is stored in a secure online database so you can have immediate access to your information on your schedule.
Before you can use their free online service, you’ll need to be a CAQH member and get a CAQH provider number. Learn about CAQH membership
After You've Applied Online
If you've applied on the CAQH website and they've confirmed your application is complete, you'll need to send an email to the Blue Cross NC Credentialing Department at email@example.com to let us know you've finished the application process. Then, we'll be able to access your application and supporting documents to complete the review process. The review process will only begin after you contact us.
Please make sure before contacting us that the credentialing application is in the "Completed" stage. Any other stage (ex. "Submitted", "First Provider Contact") will result in slowing the credentialing process.
Option 2: Manually Submit Your Application (Facilities must use this option when completing an application)
If you’d rather email, fax, or mail your information, you’ll need to fill out the application and send your documents to us.
Blue Cross and Blue Shield of North Carolina
Attention: Credentialing Department
P. O. Box 2291
Durham, NC 27702
To be able to submit claims, you' need a registered NPI number.
To Receive Direct Payment for Claims
Registration of your NPI does not guarantee direct payment. Claim payments are only made directly to you if you have an active Blue Cross NC contract.
If you wish to become a contracted provider with Blue Cross NC, select "Participation Contract Request" on the enrollment form.
Select your enrollment application below. We've also included links to instructions to help you fill out your application.
Send us your enrollment application and Taxpayer ID form:
Blue Cross and Blue Shield of North Carolina
P.O. Box 2291
Durham, NC 27702-2291
Already Have a Registered NPI Number?
If you have a registered NPI number with us, you’ve completed the credentialing step and are requesting an in-network contract, please call the Blue Cross NC Provider Service at 1-800-777-1643, option 6, to initiate your request. You can learn more about the process in Part 3 below.
Have You Left a Group To Set Up an Individual Practice?
If your NPI number was already registered due to your affiliation with another group and you're now starting an individual practice, you’ll need to complete the steps above in Part 2.
Part 3. Get a Signed Contract
Requirements For Getting a Signed Contract
Before getting a participating Blue Cross NC contract you’re required to:
- Register your NPI through the enrollment application process
The contract process takes 30 days from the date you receive confirmation of NPI enrollment. In the meantime, you should ensure Blue e and EFT registration are complete. Please refer to your enrollment letter for instructions.
If after 30 calendars days you have not heard from us, please call Blue Cross NC at 1-800-777-1643, option 6, to check the status of your contract request.