Apply for Credentialing

Credentialing Instructions

Cardiac Event Monitoring (PARTNERS Only) (Equipment Only) The DME provider network for BCBSNC closed to new providers effective 6/1/07. The DME provider network for PARTNERS closed to new providers effective 8/10/07.

Dear Health Care Provider:

The following instructions will help you understand the information required to credential your Cardiac Event Monitoring (Equipment Only).

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 is a required legal document. For multi-site pharmacies, one corporate application with appropriate credentialing documentation for each site will be acceptable.
• A copy of the exemption letter from the state Board of Pharmacy or Board of Pharmacy Permit-Devise and Medical Equipment Permit is required.
• Durable Medical Equipment (Equipment Only) must be either accredited, Medicare or Medicaid certified.
• Medicare/Medicaid verification is needed (if applicable).
  Note: A current copy of the Medicare and Medicaid Remittance Advise Summary (RA) from the facility will meet this criterion.
  If you are not Medicare and/or Medicaid certified, please provide an explanation.
  Note: If applying for the PARTNERS National Health Plan (PNHP) network Medicare certification is required.
• One of the following accreditation certificates is needed (if applicable):
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • The Community Accreditation Program, Inc. (CHAP)
  • Accreditation Commission for Health Care (ACHC)
  • International Standards Organization (ISO)
  • The Compliance Team Inc.'s "Exemplary Provider Award Program"
• 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 the provider answers yes to any questions on the application under section 1.G, the following information is necessary to process the application:
  • 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