Learn how to join the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network, maintain your in-network status, and be added to a group that's already in-network.
Individual practitioners are licensed health care professionals who have a Type 1 National Provider Identification (NPI) and personally deliver care. This includes physicians, nurses, and therapists.
If you’re unsure which NPI type you have, use the National Plan and Provider Enumeration System lookup to confirm.
If you are an individual practitioner who is new to Blue Cross NC because you've moved to the area, live in a neighboring state, or are currently not in-network, you'll need to complete a few steps to join our network.
Register with the Council for Affordable Quality Healthcare (CAQH) and keep your profile up-to-date. Credentialing verifies your education, training, licensure, and professional history.
After registering, email your CAQH ID to credentialing@bcbsnc.com.
Submit the Individual Practitioner Enrollment form.
Enrollment tells us where and how you practice so we can register your NPI in our systems.
After you receive confirmation that you’ve been credentialed and enrolled, you must register for the Blue e provider portal 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 are an individual practitioner who is credentialed with Blue Cross NC and currently practice with one group or facility but will begin practicing with another group that is already in our network, you'll need to complete the following process:
You'll need to update your practice location and affiliations in CAQH. Once updated, email your CAQH ID to credentialing@bcbsnc.com.
If you are not sure whether you are credentialed, start with CAQH. We’ll use that information to confirm your status.
Enrollment ensures your services are billed and paid correctly at each location. Even if you’re already credentialed, enrollment links you, your NPI, and your new practice location in our systems. Without this step, claims may be delayed or denied.
If you are adding yourself to one or two new locations or if you're the only practitioner being added, complete the Individual Practitioner Enrollment form.
If a group needs to add multiple practitioners or a group is expanding locations, complete the Group Enrollment form. This form can be used if there are 50 or more practitioners or locations.
Blue Cross NC initiates recredentialing as you approach your three-year credentialing cycle.
To maintain your in-network status, you need to keep your CAQH profile complete and current. You also need to maintain current attestation in CAQH.
You also need to keep your personal and practice information up-to-date by:
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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