Apply for Credentialing

Credentialing Instructions

Orthotics and Prosthetics (Breast Prosthetics Only) The O&P provider network for BCBSNC closed to new providers. The O&P provider network for Blue Medicare HMO and Blue Medicare PPO plans closed to new providers.

Dear Health Care Provider: Orthotics and Prosthetics (Breast Prosthetics Only)

The following instructions will help you understand the information required to credential your Orthotics and Prosthetics (Breast Prosthetics Only) 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.
  • Orthotics and Prosthetics (Breast Prosthetics only) must be either accredited or certified by Centers for Medicare and Medicaid (CMS).
  • One of the following accreditation certificates is needed (if applicable):
    • The American Board of Certification (ABC)
    • The Board of Orthotist/Prosthetist Certification (BOC)
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Community Health Accreditation Program (CHAP)
    • HealthCare Quality Association on Accreditation (HQAA)
    • National Association of Boards of Pharmacy (NABP)
    • The Joint Commission (JCAHO)
    • The Compliance Team, Inc.
    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)
    • Accreditation Commission for Health Care, Inc. (ACHC)
  • A copy of the BOC for an individual provider at the facility is acceptable accreditation if the facility is not accredited.
  • Medicare/Medicaid verification is needed for each site (or letter attesting to all covered sites) 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 must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million occurrence/$3 million aggregate. If more than one site is covered under the general liability malpractice insurance policy, a letter attesting to all covered sites is required.
  • If the provider is not currently accredited and answers yes to any questions on the application under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
    • Number of cases less than $200,000
    • If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.

 

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