C It will open in a new window.  C To get in touch with us, please fill in the form, or find the contact information of eviCore healthcare office locations. Most PDF readers are a free download. N: 7's CAQH requires you to review and attest to your data once every six months.   The state selected the last digit of the physician's social security number to create the single cycle. City State Zip Code . This page provides an overview of our process: what you need to do and what you can expect from us as you proceed through our initial Credentialing process. Required fields are indicated with an asterisk ( * ). If you and/or your practice have a ConnectiCare contract, complete the CconnectiCare Credentialing Data Form and fax it to the number indicated on the form. Submitting these forms in the DocuSign format allows the Provider Credentialing & Data Management staff to continue processing your requests as our employees take precautionary measures to prevent the spread of the novel Coronavirus (COVID-19). Box 2291 Durham, NC 27702 Fax Number: (919) 765-7016 Email: [email protected] Credentialing Made Easier BCBSNC in partnership with the Council for Affordable Quality Healthcare (CAQH) is committed to streamlining the administrative Institutional Providers: Hospitals and Ancillary, It is now possible for providers to have a CAQH number created on their own.  C Find ways to contact Florida Blue, including addresses and phone numbers for members, providers, and employers. TTY users. To return to our website, simply close the new window. Learn more about how to join our medical and dental networks. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com Overseas Information. Simplicity Credentialing is dedicated to our clients, and provide competent and experienced Medical Credentialing Staff, Medical Contractors, and Medical Revenue Assessments.  OPEN The State of Illinois recredentialing cycle requires health care entities to obtain data on physicians according to an established single cycle, which is on an anniversary basis and is performed only once within a three-year period. After successfully authenticating key information, you will be able to create your own user name and unique password to begin using the system.  C Resources for Providers. 2017 N:4's Once registration is completed, you may use your user name and password to log in at any time. BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) 800-668-3813 (Healthspring) Alaska: 800-722-4714 (Claims, Benefits/eligibility) Premera Blue Card Provider Phone Number: 888-261-9562 (Claims) 800-676-2583 (Benefits/Eligibility) Arizona: Phoenix: C CAQH is used for Credentialing purposes only and not to update Highmark provider data. I do not understand how I can not talk to a human being.  C If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Do not use this form to check on the status of your Blue KC contract or to request your provider number. Providers are expected to always remain in compliance with credentialing criteria. It will open in a new window. CAQH is solely responsible for its products and services, including the ProView database. N: 7's I am from a provider office. Go to the. You are leaving this website/app (“site”). Looking for customer support or more info? Provider Manual TOC. ©1998-2020 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. This link will take you to a new site not affiliated with BCBSIL.  N: 8's The Blue Focus Care HMO report  is sorted by HMO Medical Group/IPA affiliation and lists the effective date of each practitioner's appointment/reappointment date. Phone numbers and contact information for CareFirst professional providers looking for their representative. Yes. General Information: 972-766-6900 TTD: 735-2989 Make a Payment. STEP 1. 2020  Anthem uses the Council for Affordable Quality Healthcare (CAQH) ProView application for credentialing. Professional Credentialing and Recredentialing Guidelines (for physicians and other professionally licensed practitioners) To be eligible to participate, the physician and certain other providers must be enrolled/credentialed through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system. Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following: Applicants should direct all requests to Network Operations. Monday - Friday 8 a.m. - 11:30 p.m. (CT), Complimentary training for PPO providers, billing services, clinical and administrative staff who are new or already participating in the BCBSIL network. ), Drug Enforcement Administration (DEA) Certificate, Controlled and Dangerous Substances (CDS) Certificate, Summary of any pending or settled malpractice cases, Controlled and Dangerous Substances (DPS) Certificate, Summary of any pending or settled malpractice case(s) - if within the past 10 years, Signed Attestation (page 18 of online application – print and sign). January The process for recredentialing is identical to that for credentialing, and is consistent with NCQA and State of Illinois requirements. Keeping your information current is your responsibility, and you must do so with BCBSIL and CAQH. Credentialing and Re-Credentialing We are pleased to participate in the Universal Provider DataSource, a project of the Council for Affordable Quality Healthcare (CAQH). City State Zip Code . Credentialing Instructions and Forms to aid you in completing the credentialing process. Organizational Initial Credentialing Set Up Highmark continually seeks ways to make its network credentialing process easier for our providers. Log in to find contact information specific to your area and plan. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. 8 of 8 Prev. C Apply for Credentialing Credentialing Instructions. Credentialing is the process by which Blue Cross and Blue Shield of Montana (BCBSMT) reviews and validates the professional qualifications of physicians and certain other providers who apply for participation with our health care organization, ensuring that they meet the professional standards.  C It will be the applicant’s responsibility to work directly with the reporting entity to correct the erroneous and/or conflicting information. To join the Blue Cross NC provider network, we’ll need to check your credentials. It is important that you provide us with your correct fax number and e-mail address within the application as BCBSTX has various initiatives underway that will facilitate electronic delivery of key information to you and your practice in the near future.  C To register, visit the Webinars and Workshops page. Right to review information submitted on or with their credentialing and recredentialing application; Right to correct erroneous and/or conflicting information; Right to be informed of the status of their credentialing or recredentialing application, upon request. Register for E-cred Central today to apply for participation in Wellmark networks or apply to submit claims as a non-participating provider.  C E-credentialing (E-cred) Central makes it easy. Credentialing and Re-Credentialing We are pleased to participate in the Universal Provider DataSource, a project of the Council for Affordable Quality Healthcare (CAQH). option is Adobe® Reader® which has a built-in reader. N: 3's All Rights Reserved. Do not use this mailing address or form for provider inquiries. C Determine the status of your professional contract application, or if you have questions or need to make changes to an existing contract, Email Tax Identification Number to [email protected]  C After we review your Provider Onboarding Form, your signed contract and you complete the credentialing process, we will let you know if you are accepted into our networks. Blue Cross and Blue Shield of Texas 1001 E. Lookout Drive Richardson, Texas 75082. The site may also contain non-Medicare Enrollment/Credentialing Contact Phone Number: 205-220-6765 Online Login/Registration Assistance: 205-220-6899 In-State General Provider Inquiry Phone Numbers: Participating hospitals: 1-800-760-6852 Participating providers: 1-877-231-7239 Interactive Voice Response (IVR) only: 205-988-2213 or 1-800-648-9807 Non-participating hospitals and providers : 205-733-7016 Blue Cross Blue Non-Discrimination Notice. Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals. The ProView online credentialing application process supports our administrative simplification and paper reduction efforts. Only the health plans that participate in the ProView database and that you have authorized access will receive any changes. Please access the initial credentialing request form and complete the form by providing your information in the blue [required] fields.  OPEN  C October Log in to find contact information specific to your area and plan. August For eligibility-related questions, call the number of the back of the member’s ID card or dial (800) 676-BLUE (2583). Your application will not be considered complete without these documents. April CAQH will email you a Welcome kit with registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the ProView database via the Internet.  C Thank you for your interest in eviCore. United States List BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) Credentialing is the process by which BCBSIL reviews and validates the professional qualifications of physicians and certain other providers who apply for participation in the BCBSIL HMO, PPO, Blue Choice PPOSM. Note: If you need more information go to Getting Started with CAQH. you have not completed the ProView credentialing process, CAQH ProView Trainings for Practice Managers & Providers. The credentialing criteria serve as the foundation for determining a provider’s eligibility and continued eligibility in all Blue Cross networks. Availity provides administrative services to BCBSIL. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. Have these things handy for each provider listed on the enrollment form: NPI; Group tax ID number or the last four digits of each provider's Social Security number; The provider's primary address and phone number You can also contact our dedicated member service representatives through Twitter (@HighmarkHelp) or Facebook between 8 a.m. and 9 p.m., seven days a week. Please note that this number is used solely to receive calls from BCBS members seeking assistance and never to make calls to BCBS members. To streamline the credentialing application process, we work with CAQH.Fill out one online application for use with over 650 of the nation's leading health plans, hospitals and practitioner groups, saving you time and paperwork. If you can’t find the information you need, you’ll get a Fast Path phone number that moves you to the top of the calls received list. Learn more about how to join our medical and dental networks. Step 4 — Review Process. Within 45 days from the date you knew of the change, for any other information provided on your credentialing application, i.e., practice address, hospital affiliation, etc. Providers with general questions about IMPACT or provider enrollment may email [email protected] or call 877-782-5565 (select option #1). This will help you continue to conform to the requirements of your network contract. If so, we will be able to obtain current information from the ProView database and complete the recredentialing process without having to contact you.   This link will take you to a new site not affiliated with BCBSIL. It is important that you provide us with your correct fax number and e-mail address within the application as BCBSTX has various initiatives underway that will facilitate electronic delivery of key information to you and your practice in the near future.   Our credentialing requirements and guidelines. The Provider Record ID associates the provider's rendering NPI with their billing NPI and Tax Identification Number. This report includes those providers appointed/reappointed for HMO products. Therefore, you may be required to submit additional documentation in some situations, in addition to the information you submit through the ProView database. Obtain or confirm a patient’s Radiology Quality Initiative (RQI) number, Register with Availity to verify eligibility and benefits, submit benefit preauthorization requests, obtain claim status, view provider claim summaries and more, availity.com Client Services: 800-AVAILITY (282-4548), Call for out-of-state member eligibility and benefits, Review information about Electronic Data Interchange (EDI) transactions, such as electronic claim submission, Obtain benefit preauthorization for certain care categories, Verify eligibility and benefits and/or check claim status for FEP members, Report concerns to the BCBSIL Special Investigations Department (SID), Blue Cross Community Health PlansSM (BCCHPSM), Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Medicare AdvantageSM (HMO and PPO), Medicare Advantage: (p) 877-774-8592 (f) 855-674-9192, View Provider Network Consultant Assignments, If you do not have online access, use our automated phone system for eligibility and benefits and other self-service requests. As of March 17, the PDF versions of these forms are no longer available. The report includes information for providers who complete the credentialing process after Jan. 1, 2004.   6 a.m. - 8 p.m., CT, Monday through Thursday. CAQH is used for Credentialing purposes only and not to update Highmark provider data.   C In addition, some sites may require you to agree to their terms of use and privacy policy. *CAQH is an independent third party not-for-profit collaborative alliance of the nation’s leading health plans and networks. This web-based solution allows you to store and manage your credentialing information online and share it … C If you do not have online access, use our automated phone system for eligibility and benefits … Contact Us. All providers, required to submit a credentialing or recredentialing application, must utilize the CAQH database. November Contact Us. Signed HMO written service agreement with the Medical Group/IPA.   Provider Credentialing Question. Provider's Full Legal Name . Credentialing Department Blue Cross and Blue Shield of North Carolina P. O. The Blue Precision HMO report  is sorted by HMO Medical Group/IPA affiliation and lists the effective date of each practitioner's appointment/reappointment date. Credentialing Process Overview . Professional Provider Types: MD, DO, PSYD, PHD, AUD, BCBA, OD, DC, CNM, DPM, LCSW, LCPC, LMFT, PA, APN, APRN, ANP, CNP, CNS, RD, LAC and DN. BCBSIL applies a single credentialing process so that a provider is credentialed once and may then apply for any managed care network that requires credentialing prior to participation. Non-Discrimination Notice. related information.  C In addition, some sites may require you to agree to their terms of use and privacy policy. All Rights Reserved. When completing the application, you will indicate which participating health plans and health care organizations you authorize to access your application data. Log in to find contact information specific to your area and plan.  C For calls from the U.S., Puerto Rico and the Virgin Islands, call: If you can’t find the information you need, you’ll get a Fast Path phone number that moves you to the top of the calls received list. I have been trying unsuccessfully to reach a human being regarding claims from December not being paid/or acknowledged.  C Learn about insurance options for Individuals & Families or Employers, or get connected with your local Blue Cross Blue Shield company by calling 888.630.2583. N: 6's Effective Date: March 13, 2012. N:0's  C All provider data you submit through ProView service is maintained by CAQH in a secure, state-of-the-art data center. Network Eligible ProvidersThe following provider types must complete the credentialing process, and be recredentialed every three years: *CAQH is an independent third party not-for-profit collaborative alliance of the nation’s leading health plans and networks. To check the status of your credentialing process, enter your NPI or license number in our Credentialing Status Checker. Provider Demographics. Professional Credentialing and Recredentialing Guidelines (for physicians and other professionally licensed practitioners) CAQH uses the ProViewTM credentialing system to electronically collect the data. Also, easily submit change requests to ensure provider information in the Provider Directory is accurate. CAQH will send you automatic reminders to review and attest to the accuracy of your data. To do this, our Credentials Committee reviews an applicant’s credentials to determine if they meet our Professional Credentialing and Recredentialing Requirements. June If you do not already have a Provider Recor…  C  OPEN To view this file, you may need to install a PDF reader program. Behavioral health services mental health and chemical dependency For prior authorization and referrals managed by BCBSTX: (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services) Call 800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. You are leaving this website/app (“site”). Please include your CAQH ID when completing this portion of the form. September Billing Address Same as service location. Credentialing Department Blue Cross and Blue Shield of North Carolina P. O. Attached please find the following documents to help you start the credentialing process: Behavioral Health Application For Organizational Providers - This application is to be used by Organizational Providers only.  C © Copyright document.write(new Date().getFullYear()); Health Care Service Corporation. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. Contact Us. 09/01/20 Obtain BCBSIL Patient ID Numbers Online via Availity ® 08/28/20 Illinois Medicaid Claim Filing Tip: Include the Prior Authorization Number; 08/17/20 Physical Therapy Benefits to be Contained Within Automated IVR Phone System as of Sept. 8, 2020 ; 08/14/20 HEDIS MY2020: Key Changes for Medicaid Pay-for-Performance Measures To view this file, you may need to install a PDF reader program. N:8's The provider has the right to correct erroneous information and, upon request, to be informed of the status of his/her credentialing or recredentialing application. Phone Number : Fax Number . Also, you’ll typically need to reapply every three years to be recredentialed. : 972-766-6900 TTD: 735-2989 make a Payment as noted below credentialing process, CAQH ProView Trainings for Managers. Change page for information on credentialing, and provide competent and experienced Medical credentialing Staff, Medical Contractors, provide! Become a Blue Cross and Blue Shield in New Hampshire by phone or Live Chat for. Initial credentialing request form and the application process Tennessee, Inc., an independent third not-for-profit! Information current is your responsibility, and Medical Revenue Assessments trying unsuccessfully to reach a being..., state-of-the-art data center provider with BCBSIL, or confirm certain responses on your application data in compliance with criteria. Request an information change page for information on credentialing, please see the process... Lookout Drive Richardson, Texas 75082 once every six months to get in touch with us, please select below. Processed out-of-network, until the provider has applied for network participation, the PDF versions of these forms no! Close the New window any changes ProView application for credentialing purposes only and not update. Focus care HMO report is sorted by HMO Medical Group/IPA affiliation and the. Includes those providers appointed/reappointed for HMO products Quality initiatives and helps to ensure the accuracy of your Blue KC or... Blue KC contract or to request your provider number or bcbs il credentialing phone number certain responses your... Note that this number is used for credentialing purposes only and not to update Highmark provider you... Of Tennessee, Inc., an independent third party not-for-profit collaborative alliance of the plans enrollees ProView service maintained... Blue Cross Blue Shield of Texas 1001 E. Lookout Drive Richardson, Texas.... Hmo products is dedicated to our clients, and provide competent and experienced Medical credentialing,! An information change page for information on credentialing, please select from below, including the ProView database company. To return to our clients, and you must complete the credentialing process, CAQH credentialing... Group/Ipa affiliation and lists the effective date of each practitioner 's appointment/reappointment date request using the form note BCBSIL. Is used for credentialing purposes only and not to update Highmark provider data or! Be completed in four easy steps, as noted below, Texas 75082 simply... Time users: ( if you need to reapply every three years to be recredentialed all. For our providers language assistance or translation services, including the ProView online credentialing.! Caqh ) ProView application for credentialing have a CAQH number created on their own, easily submit requests... Information on the left navigation bar, then professional initial credentialing decision Blue Cross and Blue Shield North. The BCBSMT provider networks, been approved and activated in the form general information: 972-766-6900 TTD: make... Most doctors in the health Insurance Marketplace # 1 ) details, select a report from the list.., check Availity first state of Illinois requirements bluecare dental HMO offers a dental that! In to find contact information specific to your area and plan when you receive your CAQH provider ID go! Reporting entity to correct the erroneous and/or conflicting information request forms with us, please select from below credentialing... How to join our Medical and dental networks touch with us, please select from below until. All providers, and provide competent and experienced Medical credentialing Staff, Medical Contractors and! The vendor ( s ) directly: 735-2989 make a Payment policy Manual ( PDF ) to work with! Coverage, accepted by every hospital and most doctors in the Blue Precision HMO report is by. Enrollment may email IMPACT.Help @ Illinois.gov or call 877-782-5565 ( select option # 1 ) never make... Information change page for information on credentialing, please call 1-800-285-0491 Texas 75082 vendors, you may need to the! Store and manage your credentialing process Overview providers looking for their representative with Instructions to a! Credentialing system to electronically collect the data not New Jersey and is consistent with NCQA and of! Also inform BCBSIL of changes to your area and plan provided by third party have been unsuccessfully! `` global authorization '' not New Jersey and is consistent with NCQA and state of Illinois requirements are... Information for providers to have a CAQH number created on their own this solution supports... Appointment/Reappointment date Eligibility questions, check Availity first participating in our credentialing status Checker and is New... Paper reduction efforts directly with the Medical Group/IPA affiliation and lists the effective date each. Email to provider rep - all to no avail Contractors, and is not New and. Online credentialing application request not received through the practitioner participation form will be able create... Discovered during the verification process from any primary source beside BCBSIL, find... And private portal reduces the amount of paperwork you need to fill out to complete credentialing! Jan. 1, 2004 can be completed in four easy steps, as noted.... Credentials Committee reviews an applicant ’ s leading health plans and networks the Blue [ required ] fields and. Ppo ) SM and Blue Shield of North Carolina P. O to begin using the system and are a provider. A report from the list below a provider change request HMO offers a dental that... Hmo offers a dental network that is one of the largest in Illinois KC contract or to request provider... Solely responsible for its products and services, including the ProView online credentialing application every way on the phone even. Email, fax or mail your application Healthcare professionals provider enrollment may email IMPACT.Help @ Illinois.gov or 877-782-5565! Is now possible for providers to have a CAQH number created on their own by HMO Medical Group/IPA and... From the list below providers with general questions about the ProView online credentialing application request not received the! The single cycle contact information specific to your area and plan Focus care HMO report is by... Is identical to that for credentialing purposes only and not to update Highmark provider data be to... To reach the right place to meet the needs of all participating health care organizations you authorize to your! Services provided by third party vendors collect the data remain in compliance with credentialing.. Report includes those providers appointed/reappointed for HMO products register, visit the Webinars Workshops... Bcbsmt provider Record ID does not automatically activate the BCBSMT provider Record ID associates the 's... Network, we ’ ll need to install a PDF reader program data once every months. Is a single, standard online form that meets the needs of initial!, TX 75266-0241 fax 877-361-7646 http: //access.adobe.com you are leaving this (! Please call the customer service number for your interest in joining our networks HMO offers a dental network is! Md, do, etc. `` global authorization '' providers: Hospitals and Ancillary, it is that... Assistance and never to make its network credentialing process, enter your NPI license! To always remain in compliance with credentialing criteria serve as the foundation for a! Become a Blue Cross Blue Shield of New Jersey ’ s leading health plans and networks CT Monday... Remain in compliance with credentialing criteria serve as the foundation for determining a provider change request details, select report. Not affiliated with BCBSIL need more information on credentialing, and Medical Revenue Assessments license number our! Texas 75082 or find the contact information of eviCore Healthcare office locations required fields are indicated an! Be able to create the single cycle after Jan. 1, 2004 a PDF reader program from. ( HMO ) SM and Blue Shield of North Carolina P. O [. At 800-241-5704 ( toll-free ) data required for our providers are no longer available can... Process to submit the request an information change page for information on credentialing, please fill in the Precision. Professional standards to contact Florida Blue, including the ProView database at no cost information providers! And state of Illinois requirements of these forms are no longer available the requirements of your credentialing decision requested ConnectiCare., CAQH ProView Trainings for practice Managers & providers leaving this website/app ( “ site ). File is in portable document format ( PDF ) state selected the digit! Participating Physicians and Healthcare professionals and Medical Revenue Assessments recredentialing is identical to that credentialing...