The Process - BCBS Insurance Credentialing Services

BCBS Insurance Credentialing Services

The Process - BCBS Insurance Credentialing Services

Blue Cross Blue Sheild (BCBS) is a renowned federation consisting of 36 different Health Insurance organizations and companies.

BCBS not only consists of different established, publicly traded and privately owned insurance providers like Premera, Highmark, Anthem, Carefirst, Cambia health solution etc., but also caters to a large population of 106 million citizens in the United States.

In order to tap into the pool of potential clients covered by Blue Cross Blue Shield, applying for their credentialing services is a crucial step for practitioners. Becoming an in-network provider is fairly complicated and lengthy, as is a three-part process that requires a third-party service provider who specializes in credentialing services and simplifies the entire process.

This is where Bikham Healthcare comes in. Let Bikham take you through the steps for getting credentialed with BCBS. Let's begin the introductions to the three-part process:

1. Get yourself Credentialed or Re-credentialed - As a protocol, BCBS initially verifies the credentials of medical practioners who apply for Insurance Credentialing Services. The practioners are required to submit their resume, work history and other related information for the verification of their background. This process can be accomplished by sending the applications and documents online, or can be done manually.

Only providers are exclusive to apply for Insurance Credentialing Services with BCBS. After receiving an application, the information is sent to the Universal Credentialing DataSource(UCD). To make the entire process more efficient, BCBS also works closely with the Council of Affordable Quality Healthcare.

Manual applications are mandatory only for facilities who are not providers.

2. Get an NPI - The National Provider Identification Number, generally addressed, as the NPI is a 10-digit identification number. This number is used to replace provider identifiers like the unique identification number in HIPAA standard transactions.

All healthcare provider are required to have the NPI as per HIPAA guidelines. Without the NPI, you cannot apply to get in-network with BCBS.

3. Getting Contracted - As an initial step to get a signed contract with BCBS, you are required to register your NPI through the enrollment application process, then register to be able to access Explanation of Payments(EOP), along with signing an EFT to receive claim payments. This process takes 30 - 45 days from the date of NPI enrollment.

In a nutshell, its’ important to know that getting in-network with BCBS is a lengthy and complex process. It takes about 90-120 days for the entire process to be approved and completed. Not to miss the ever-detailed paperwork which requires attention and regular follow-ups. At times, there is a possibility of the application rejected too.

This is what Bikham is for. Our team of experts take you through the entire process without any hassles and lets you concentrate on other stuff that is important for you.

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