Whether you’re new to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) or expanding an existing group, learn what you need to do to get, adjust, and maintain your in-network status.
A group practice is an organization that represents multiple individual practitioners and has a Type 2 National Provider Identification (NPI). Group practices are separate from facilities, such as surgery centers.
If you’re unsure which NPI type you have, use the National Plan and Provider Enumeration System NPI lookup to confirm.
If you're a group practice that is new to Blue Cross NC and want to participate in our network, there are a few steps you need to take to complete the process.
Register your group with the Council for Affordable Quality Healthcare (CAQH). Credentialing verifies your education, training, licensure, and professional history. It also verifies required group and provider information.
Email your group’s CAQH ID to credentialing@bcbsnc.com.
Submit the Provider Group Enrollment form.
Enrollment tells us where and how your group practice is structured so we can register your NPI in our systems.
After you receive confirmation that you’ve been credentialed and enrolled with Blue Cross NC, you will need to register for the provider portal Blue e to submit and track claims. You'll also need to sign up for Electronic Funds Transfer to receive payments from Blue Cross NC.
After completing the first three steps, you'll receive a Network Participation Agreement.
If you don’t receive your agreement within 30 days of finishing these first three steps, contact us at 800‑777‑1643, option 6.
If you're a group practice that is participating in the Blue Cross NC network and is adding new providers and/or changing practice locations, you'll need to complete the following steps:
Any providers being added to the group practice, including providers new to the Blue Cross NC network, must register with CAQH and email their CAQH ID to credentialing@bcbsnc.com before enrollment.
If they're already registered with CAQH, they will need to make sure their information is up-to-date before continuing the process.
Enrollment is required whenever providers or locations are added, even if the group practice is already in network. The process ensures providers, locations, and NPIs are correctly registered so claims and payments are processed accurately.
If you are adding one provider and this provider will practice at one or two locations, complete the Individual Practitioner Enrollment form.
If you are adding multiple providers and/or you're adding or changing multiple locations, complete the Group Enrollment form.
Blue Cross NC initiates recredentialing as groups currently participating in the Blue Cross NC network approach the three-year credentialing cycle. Maintaining current information helps avoid payment delays and ensures providers remain visible to members.
To maintain your group's in-network status, you need to attest in CAQH every 120 days. Also be sure your personal and practice information is up-to-date by:
If your organization manages its own credentialing and wants to do so officially on behalf of Blue Cross NC, delegated status may be the right next step. Delegation allows you to take the lead while we stay closely aligned and accountable together.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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