Provider and facility applications

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

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:  

• Use CAQH Provider Data Portal for initial credentialing and recredentialing with Blue Cross NC.  
• Complete the new online Individual Practitioner Enrollment Form for enrolling new practitioners

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.