Individual practitioners
Who are individual practitioners?
Individual practitioners are licensed health care professionals who have a Type 1 National Provider Identification (NPI) and personally deliver care. This includes physicians, nurses, and therapists.
If you’re unsure which NPI type you have, use the National Plan and Provider Enumeration System lookup to confirm.
How to join the Blue Cross NC network as an individual practitioner
Register with the Council for Affordable Quality Healthcare (CAQH) and keep your profile up-to-date. Credentialing verifies your education, training, licensure, and professional history.
After registering, email your CAQH ID to credentialing@bcbsnc.com.
Submit the Individual Practitioner Enrollment form.
Enrollment tells us where and how you practice so we can register your NPI in our systems.
After completing the first three steps, you'll receive a Network Participation Agreement.
If you don’t receive your agreement within 30 days of finishing these first three steps, contact us at 800‑777‑1643, option 6.
How to join an already in-network group
You'll need to update your practice location and affiliations in CAQH. Once updated, email your CAQH ID to credentialing@bcbsnc.com.
If you are not sure whether you are credentialed, start with CAQH. We’ll use that information to confirm your status.
Enrollment ensures your services are billed and paid correctly at each location. Even if you’re already credentialed, enrollment links you, your NPI, and your new practice location in our systems. Without this step, claims may be delayed or denied.
If you are adding yourself to one or two new locations or if you're the only practitioner being added, complete the Individual Practitioner Enrollment form.
If a group needs to add multiple practitioners or a group is expanding locations, complete the Group Enrollment form. This form can be used if there are 50 or more practitioners or locations.
How to complete recredentialing and maintain in-network status
Blue Cross NC initiates recredentialing as you approach your three-year credentialing cycle.
To maintain your in-network status, you need to keep your CAQH profile complete and current. You also need to maintain current attestation in CAQH.
You also need to keep your personal and practice information up-to-date by: