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Providers

Provider and facility applications

We're working to streamline the administrative process for physicians and other health care providers to make getting credentialed easier.

Provider application (credentialing + enrollment)

Before we begin, are you a nurse practitioner, physician assistant or certified nurse midwife?

If yes and you’re starting your own practice, you will need to confirm your supervising provider is already credentialed with Blue Cross NC by calling 800-777-1643 option 6. Your supervising provider needs to be credentialed with Blue Cross NC first before we can review your credentialing application. 

 

If your supervising provider is uncredentialed, they will need to follow the steps on this page to begin the credentialing process.

Step 1 of 4

Get credentialed with CAQH Provider Data Portal

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) credentials all practitioners of care, ancillary and facility providers applying for membership in the network(s). 

All providers and facilities in our network need to be recredentialed every three years.

Step 2 of 4

Email Blue Cross NC with CAQH ID #

Send an email to credentialing@bcbsnc.com with your CAQH ID number. Make sure you've completed your CAQH application before emailing us. We'll start reviewing once we receive your email. 

Step 3 of 4

Complete and email taxpayer W-9 ID form to Blue Cross NC

Providers joining our network must complete a W-9 taxpayer ID form. Use this instructional guide for help (PDF).

Once finished, email form to ProvRequests@bcbsnc.com.

Step 4 of 4

Register your NPI number

Providers need to register their NPI number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered. Only providers with a Blue Cross NC contract can receive direct payment.

Have you already registered your NPI?

If you are an out-of-network provider who previously received payment for services from Blue Cross NC, you have already registered your NPI with us if. You will need to contact Blue Cross NC Provider Service at 800-777-1643. Choose option 6 to continue the enrollment process.

Use this instructional guide for help (PDF) completing the taxpayer W-9 form.

Providers who want to contract with Blue Cross NC

Begin contract process

Once you have become credentialed and enrolled with your registered NPI number and tax ID, you can begin the contracting process. 

To begin the process, call 800-777-1643 (option 6). Please allow at least 60 days for Blue Cross NC to process your application. This process could take longer if there is incomplete or inaccurate information in your application. 
 
If after 60 days you have not heard from us, please call us again at 800-777-1643 (option 6) to speak to with us about:  
  • Status inquiries  
  • Credentialing/recredentialing inquiries  
  • Enrollment questions  
  • Contracting questions 

While you're waiting for your contract to be processed, you can sign up for Blue e and set up electronic funds transfer. 

Step 1 of 1

Register your NPI number for payment

Providers need to register their NPI number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered. Only providers with a Blue Cross NC contract can receive direct payment.

Use this instructional guide for help (PDF) completing the taxpayer W-9 form.

Step 1 of 1

Get recredentialed with CAQH Provider Data Portal

Blue Cross NC credentials all practitioners of care, ancillary and facility providers applying for membership in the network(s). 

All providers and facilities in our network need to be recredentialed every three years.

Providers who want to contract with Blue Cross NC

Begin contract process

Once you have recredentialed, you can begin the contracting process. 

To begin the process, call 800-777-1643 (option 6). Please allow at least 60 days for Blue Cross NC to process your application. This process could take longer if there is incomplete or inaccurate information in your application. 
 
If after 60 days you have not heard from us, please call us again at 800-777-1643 (option 6) to speak to with us about:  
  • Status inquiries  
  • Credentialing/recredentialing inquiries  
  • Enrollment questions  
  • Contracting questions 

While you're waiting for your contract to be processed, you can sign up for Blue e and set up electronic funds transfer. 

Facilities application (credentialing + enrollment)

Step 1 of 3

Complete and submit facility credentialing form

Download and complete the PDF form. Then submit your application with one of these options:

Email credentialing@bcbsnc.com

Fax to 919-765-7016

Step 2 of 3

Complete and email taxpayer W-9 ID form to Blue Cross NC

Providers joining our network must complete a W-9 taxpayer ID form. Use this instructional guide for help (PDF).

Once finished, email form to ProvRequests@bcbsnc.com.

Step 3 of 3

Register your NPI type II number

Facilities need to register their NPI type II number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered. Only providers with a Blue Cross NC contract can receive direct payment.

Have you already registered your NPI?

If you are an out-of-network provider who previously received payment for services from Blue Cross NC, you have already registered your NPI with us if. You will need to contact Blue Cross NC Provider Service at 800-777-1643, choose option 6 to continue the enrollment process.

Step 1 of 1

Register your NPI type II number for payment

Facilities need to register their NPI type II number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered. Only providers with a Blue Cross NC contract can receive direct payment.

Step 1 of 1

Complete and submit facility recredentialing form

Download and complete the PDF form. Then submit your application with one of these options:

Email credentialing@bcbsnc.com

Fax to 919-765-7016

Credentialing rights and requirements

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
  • Board Certified Behavior Analyst
  • 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

  • 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

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.

All practitioners applying for credentialing and recredentialing have the following rights:

  • To review information submitted to support their credentialing application
  • To correct erroneous information within 45 days from the notification
  • To be informed, upon request, of the status of their credentialing or recredentialing application 
  • To be notified verbally or in writing of any information obtained during the organization’s credentialing process that varies substantially from the information provided to the organization by the practitioner

Credentialing/recredentialing updates

All initial credentialing files for Physicians

  • Any MD/DO that is Board Eligible may apply for Credentialing with Blue Cross NC Networks with the express understanding that they must become Board Certified by the time they recredential with Blue Cross NC Networks or within three (3) years.
  • Should any MD/DO that was Board Eligible upon initial credentialing, fail to obtain their Board Certification on or before their recredentialing date, specifically within three (3) years, shall be immediately terminated.
  • All other MD/DOs, that were Board Eligible upon initial credentialing, and obtained their Board Certification within the three (3) year deadline, shall be eligible for recredentialing within the Blue Cross NC Networks.
  • All MD/DOs will be credentialed in the respective field they are Board Eligible/Certified in.

All recredentialed files for Physicians

  • All MD/DOs that were Board Eligible and have already been credentialed with the Blue Cross NC Networks, on or before April 30, 2023, are officially grandfathered into the Blue Cross NC Networks and do not have to obtain their Board Certification. These Practitioners shall remain as Board Eligible unless they willingly obtain their Board Certification.
  • Should any Recredentialed MD/DOs leave the Blue Cross NC Networks, and then return at a later date, shall be treated as an Initial Practitioner, and will be required to be Board Eligible and then obtain their Board Certification within the three (3) year credentialing cycle, in order to participate in the Blue Cross NC Networks.

Effective November 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin utilizing the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal (formerly known as CAQH ProView) universal credentialing application. The upcoming changes to our processes will improve quality and timeliness in onboarding our new providers/practitioners to Blue Cross NC. Providers will be required to do the following:  

or  

  • Complete the online Provider Group Enrollment Form for enrolling new groups  
  • Submit individual practitioner and group enrollment forms 60 days prior to the provider’s effective date; as it currently takes 60 days for a new enrollment to be processed.  

This initial step of integrating automation and streamlining onboarding processes will improve turnaround times for credentialing and enrollment.   

We appreciate your cooperation and look forward to partnering with you as we transition to a more automated and digitized workflow. Please see the FAQ which provides further guidance and instructions for utilizing these electronic processes.

 

Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.

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 Provider Data Portal (Formerly 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 the CAQH Provider Data Portal.
    • If you are not registered for CAQH Provider Data Portal and are seeking credentialing/recredentialing, please visit https://proview.caqh.org and click "register here" in option 3 under the "First Time Here?" section. If you have trouble registering, contact CAQH Provider Data Portal at 888-599-1771, Monday – Friday from 7 a.m. - 8 p.m. (ET), 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 the CAQH Provider Data Portal, 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 Provider Data Portal database.
  • Recredentialing will be delayed until provider information is complete and updated in the CAQH Provider Data Portal database.

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