Credentialing

Credentialing Subcommittee

The Medical Quality Management Committee (MQMC) is the final decision-making authority regarding provider credentialing. The Credentialing Subcommittee serves the MQMC by making suggestions and updating policies for the credentialing process. The subcommittee meets bi-monthly or more often, as needed and determined by the Medical Director of BCBSLA.

Subcommittee Responsibilities

  • Makes suggestions to the MQMC regarding provider participation
  • Recommends disciplinary and/or corrective actions against participating providers who fail to comply with the terms of their agreements and the credentialing policies and procedures
  • Amends and approves BCBSLA's credentialing and recredentialing policies and procedures annually
  • Maintains the confidentiality of all activities, policies, procedures, actions and recommendations of BCBSLA's credentialing program

Membership

The Credentialing Subcommittee is made up of a diverse group of network providers from across the state with no other management role at Blue Cross. The committee also includes multiple internal employees from Medical Management, Network Operations, and Network Development. The subcommittee requires three voting physicians to make a quorum.

Members of our Executive Management, the Medical Director, Associate Medical Director or Director of Network Development can recommend the appointment of a participating provider to the Credentialing Subcommittee for a three-year term. Members may be re-appointed for multiple terms based on mutual agreement. A provider member may resign at any time.

If you are interested in serving on our Credentialing Subcommittee, please call 1.800.716.2299, Option 3.