Update For Board Certification Criteria – Effective August 30, 2023

Previous iterations of the Board Certification Criteria were posted in an earlier news listing. Please note, this is current as of August 30, 2023.  

Board Certification Criteria 

• MD / DOs must be board certified. An MD / DO that is Board Eligible may apply for credentialing with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) networks with the express condition that they must become Board Certified by American Board of Medical Specialties (ABMS) or American Board of Osteopathic Association (AOA) or American Board of Foot and Ankle Surgery (ABFAS) or American Board of Podiatric Medicine (ABPM) or American Board of Oral and Maxillofacial Surgery within three (3) years from their initial credentialing date.  
• MD / DOs will be credentialed in the respective field in which they are Board Eligible/Certified to practice based on the application information submitted by the MD/DO.  
• MD / DO with Board Eligibility in two (2) or more specialties may apply for credentialing with Blue Cross NC, with the express condition that they become Board Certified for each specialty they wish to participate with Blue Cross NC for within three (3) years of their initial credentialing by ABMS, AOA, ABFAS, ABPM, or ABOMS.  
• All MD / DOs credentialed with Blue Cross NC April 30, 2023, or prior are grandfathered in for the board certification requirement. Nothing prohibits any Board Eligible MD / DO covered here from obtaining Board Certification and updating their Blue Cross NC file.  
• Should any MD / DO currently grandfathered, terminate from the Blue Cross NC network for any reason and later reapply for credentialing, the MD / DO shall be treated as an initial practitioner credentialing, and the terms for initial credentialing shall apply.  
• MDs and DOs meeting any one of the following criteria will be viewed as meeting the certification requirement:  
  • If Board eligibility requirements take longer than three (3) years for completion for all providers obtaining that Board certification. For example, but not limited to, certain fellowship training requiring longer than three (3) years, and foreign national physician candidates working towards Board certification. 
  • Previous board certification as defined by one of the following: ABMS, AOA, ABFAS, ABPM, or ABOMS in the clinical specialty or subspecialty for which they are applying which has now expired and a minimum of ten (10) consecutive years of clinical practice. 
  • Training which met the requirements in place at the time it was completed in a specialty field prior to the availability of board certifications in that clinical specialty or subspecialty; or  
  • Specialized practice expertise as evidenced by publication in nationally accepted peer review literature and / or recognized as a leader in the science of their specialty and a faculty appointment of assistant professor or higher at an academic medical center and teaching facility in Blue Cross NC network and the applicant’s professional activities are spent at that institution at least fifty percent (50%) of the time in active clinical patient care. 
• If provider does not meet the requirements outlined above, provider may submit an explanation for Blue Cross NC Credentialing Committee consideration.  

Delegated Credentialing 

• For existing delegated entities, as of January 1, 2024, these criteria apply for any new providers joining the delegate.  
• Any new delegated entity will be held to these criteria effective immediately.