Become a Blue Cross NC Provider or Recredential

Are you currently a Commercial PPO provider?

Are you interested in contracting for the North Carolina State Health Plan Network? Visit our new home page to find the details you need to complete your sign up.

Join the NC State Health Plan Network

Are you new to Blue Cross NC?

You’re in the right place! On this page, you'll find all the details you need to complete the full contracting 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 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.

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.

See 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

 

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)
  • 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).

Benefits:

  • 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.

To learn more about CAQH and the CAQH UCD, please visit CAQH.org where you can watch an online demonstration. You can also read our frequently asked questions for more information.

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 credentialing@bcbsnc.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.

Go to CAQH to Start Application

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.

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

Start Manual Application Process


Part 2. Register Your NPI Number

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:

Email
NMSpecialist@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

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.