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Credentialing Instructions

Home Durable Medical Equipment (Equipment Only) The DME provider network for BCBSNC closed to new providers.  The DME provider network for Blue Medicare HMO and Blue Medicare PPO are closed to new providers.

Dear Health Care Provider: Home Durable Medical Equipment

The following instructions will help you understand the information required to credential your Home Durable Medical Equipment (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 or certified by Centers for Medicare and Medicaid (CMS).
    Note: If applying for the PARTNERS National Health Plan (PNHP) network Medicare certification is requred.
  • One of the following documents is needed (if applicable):
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The Community Accreditation Program, Inc. (CHAP)
    • Accreditation Commission for Health Care (ACHC)
    • The Compliance Team Inc.'s "Exemplary Provider Award Program,"
    • Commission on Accreditation of Rehabilitation Facilities (CARF)
    • Healthcare Quality Association on Accreditation (HQAA)
    • National Association of Boards of Pharmacy (NABP)
    • The National Board of Accreditation for Orthotic Suppliers (NBAOS)
    • American Board of Certification in Orthotics and Prosthetics (ABC)
    • Board of Certification/Accreditation International (BOC)
  • 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.
    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 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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