Updated Credentialing Standards for Behavioral Health Facility Services for Facility-based Partial Hospital Programs (PHP), Intensive Outpatient Programs (IOP) and Residential Treatment Centers (RTC)

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been working diligently with external and internal stakeholders to update credentialing standards for behavioral health facility services for Facility-based Partial Hospital Programs (PHP), Intensive Outpatient Programs (IOP) and Residential Treatment Centers (RTC) to ensure our members are receiving the most affordable and high-quality health care services. 

Blue Cross NC’s credentialing requirements for licensure and accreditation, along with pertinent provider network contracting requirements, are being implemented to address gaps in North Carolina state licensure for these facility services. These changes come after significant work with entities such as the North Carolina Department of Health and Human Services (DHHS), Division of Health Service Regulation (DHSR) and the Addiction Professionals-NC (APNC).

To ensure prompt payment for the services categories listed below, please review your facility’s current licensure and accreditation with the table below. Should your facility’s current licensure and/or accreditation not meet Blue Cross NC’s updated requirements, your facility must obtain the correct licensure through North Carolina DHHS/DHSR, as well as applicable accreditation from The Joint Commission (TJC)/Commission on Accreditation of Rehabilitation Facilities (CARF).  Once the new licensure and accreditation is acquired, please submit a new credentialing application, which can be found at https://www.bluecrossnc.com/providers/network-participation.

Please note all other standard Blue Cross NC Credentialing requirements remain in place and new provider contract requirements must be met by impacted facilities.

Facility Licensure and Accreditation Requirements:

Claims submitted by facilities that are not appropriately licensed/accredited to administer these service(s) cannot be filed to Blue Cross NC for reimbursement. Impacted facilities that are already in Blue Cross NC’s network will have up to 12 months from the date of this posting to obtain appropriate licensure/accreditation.  Reference the chart below for the applicable license and accreditation requirements for the services categories:

*TJC – Joint Commission Accreditation and Certification; CARF - Commission on Accreditation of Rehabilitation Facilities

^ Provider Network Contract PLUS Contract addendum