Apply for Credentialing

Credentialing Instructions

Hospice Agencies (BCBSNC Only)

Dear Health Care Provider:

The following instructions will help you understand the information required to credential your Hospice Agency. 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 will not 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.
• Hospice must be either accredited, Medicare, or Medicaid certified.
• One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Accreditation Commission for Health Care (ACHC)
  
  If not accredited, please provide a copy of the most recent CMS Review.
• A copy of the Division of Facility Services License is required for each site.
• 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. If you are not Medicare and/or Medicaid certified, please provide an explanation.
• A general liability malpractice insurance face sheet is required and 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 required 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.