Apply for Credentialing

Credentialing Instructions

Intensive Outpatient Facilities (BCBSNC Only)

Dear Health Care Provider:

The following instructions will help you understand the information required to credential your Intensive Outpatient Facility.

To avoid delays associated with an incomplete credentialing application, please review this material carefully before attempting to complete the application. Fill in all required information completely and attach all required documents before submitting your application.

Upon completion of the credentialing process, your application will be presented to the Credentialing Committee for approval or denial. If denied you will be notified by certified mail. If approved, Network Management will contact you to finalize the contracting process and assign your effective date.

ALL APPLICANTS: Please note all fields must be COMPLETED or indicate NOT APPLICABLE (NA). All supporting required documents must be submitted or the application cannot be processed and will be returned.

• A completed signed and dated application for each site and each organization with a unique Federal Tax ID# is a required legal document.
• Intensive Outpatient Facilities must be either accredited or certified by Centers for Medicare and Medicaid (CMS).
• A copy of the Division of Health Service Regulation license.
• One of the following accreditation certificates is required (if applicable)
  • Joint Commission on Accreditation of Healthcare Organizations
  • Commission on Accreditation of Rehabilitation Facilities
  • Council on Accreditation for children and family services

  
  If not accredited, must provide the most current copy of your CMS review

• Medicare/Medicaid verification is needed (if applicable).
  _{Note: A current copy of the Medicare and Medicaid Remittance Advice Summary (RA) from the facility will meet this criterion.
  Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.} 
• A general liability malpractice insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence/$3 million per aggregate)