Recredentialing Timeliness and Administrative Term Process

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating our Practitioner Recredentialing Practices to ensure a consistent process that will prevent member abrasion when a provider misses recredentialing timelines.

Beginning December 1, providers that have recredentialing dates in February 2022 can no longer submit missing documentation when the recredentialing period has expired. Providers are notified of recredentialing requirements six months in advance of the credentialing due date.  Blue Cross NC will make three (3) attempts to contact a practitioner for missing information. After the third attempt, a final notice will be sent. Practitioners must respond within 30 days of the date of the final notice.

If the required information is not received, credentialing status will change from recredential status to de-credential status. If by the committee date the recredentialing file is still incomplete, the practitioner will be administratively terminated. Retroactive dates will not be honored. Members will be notified of the practitioner’s out-of-network status and practitioners will be required to go through initial credentialing.

We encourage providers to pay attention to recredentialing dates and notifications from Blue Cross NC or our credentialing verification organization, Verifide.  Please make sure that you are updating and attesting to your credentialing information every 120 days and demographic information every 90 days at CAQH - Streamlining the Business of Healthcare. By regularly attesting to your information, you will ensure compliance with NCQA recredentialing requirements and the new legislation requiring attestation of practitioner demographic data every 90 days.