Apply for Credentialing
Free Standing Radiology Facilities (Blue Medicare HMO and Blue Medicare PPO Networks Only)
Dear Health Care Provider:
The following instructions will help you understand the information required to credential your free standing Radiology 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.
- A copy of a NC license or Certificate of Need (if applicable per state or federal regulatory requirements)
- One of the following accreditation certificates is required:
- American College of Radiology (ACR)
- Intersocietal Accreditation Commission (IAC)
- The Joint Commission (JCAHO)
- Medicare certification is required.
- A general liability malpractice insurance face sheet is required and must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence/$3 million per aggregate) or letter attesting to all covered sites