Recredentialing

For Professional Providers

To continue participation in our network(s), providers must adhere to the same criteria and standards as required during the initial credentialing cycle. Providers are recredentialed every three (3) years from their last credentialing acceptance date. Providers are considered to be recredentialed unless notified otherwise. Providers who no longer meet criteria could be terminated from the networks according to their agreement.

Recredentialing Criteria

(As applicable by specialty)

  • Recredentialing Application
  • Current, Unrestricted Professional State License
  • Current, Unrestricted Louisiana Controlled Dangerous Substance (CDS) License and Federal DEA Certificate
  • Current Professional Malpractice Liability Insurance with minimal coverage amounts of: $100,000/300,000 with Louisiana Patient's Compensation Fund (LPCF) OR $1,000,000/3,000,000 without LPCF and the Insurance carrier rating of at least an A by AM Best Company OR Self Insured through LPCF
  • Current Active, Admitting Unrestricted Hospital Privileges
  • Curriculum Vitae—explanation of past three years' work history
  • No current Medicare/Medicaid Sanctions
  • Board Certification or Board Eligibility obtained by the American Board of Medical Specialties

The Network Operations Department preprints all recredentialing applications based on information obtained during the initial credentialing process. The application is mailed to the provider at least 180 days prior to the recredentialing deadline date to ensure ample time is allowed for verification.

The provider may make any necessary updates or changes to the information printed on the application. The provider must submit the preprinted application completed, signed and dated, along with the required documentation listed below. All information submitted must be legible, current and without restriction. We will return all submitted information to the provider if the application is not signed and dated. Signature and date must be original. Signature stamps or date stamps are not acceptable.

Application and Supporting Documentation

  • Current, Unrestricted Professional State License
  • Current, Unrestricted Louisiana Controlled Dangerous Substance (CDS) License and Federal DEA Certificate
  • Current, Certificate(s) of Professional Malpractice Liability Insurance
  • Certificate of Louisiana Patient's Compensation Fund, as applicable
  • History of malpractice claims paid (past 3 years)
  • Curriculum Vitae (CV) (past 3 years' work history)
  • Certification(s), including Educational Certifications and Training (CMEs)
  • Certification(s), including Board Certification obtained by the American Board of Medical Specialties, as applicable for re-certifications or certifications obtained since the last credentialing cycle
  • If you are a Primary Care Physician (PCP) and you have a hospitalist group admitting patients for you, you must submit a letter stating the agreement between you and the hospitalist group that is signed and dated by both parties
  • The following specialties do not require hospital privileges: Hospital Based Anesthesiology, Hospital Based Pathology, Hospital Based Radiology, Podiatric Medicine, Dermatology, Allergy & Immunology, Psychiatry and Physical Medicine & Rehabilitation (Physiatry). All pediatric subspecialties for the above specialties are included in the exception. Infectious Disease providers require consulting privileges.

The recredentialing process can take 60—90 days from receipt of the application. All recredentialing applications must not be older than 180 days at the time of the Credentialing Subcommittee meeting. The Credentialing Subcommittee must approve all providers. Providers may appeal subcommittee decisions using the guidelines on the Appeals and Terminations page.

Further Review

The Network Operations Manager and the Medical Director reviews files with significant malpractice and/or disciplinary actions. They assure enough details have been collected. After verification, the provider's file will be sent to the Credentialing Subcommittee for final review and approval or denial. All verifications and/or applications must not be more than 180 days old at the time of the decision.

Relocation

Providers are not required to be recredentialed due to an address change.

  • We may request specific credentials, as necessary, such as new hospital privileges or a copy of individual malpractice policy
  • Systems will generally be updated within 14 days after receiving new address information
  • There will be no disruption to the provider's network participation due to an address change

Submission

You may fax, e-mail or mail your application and supporting documents to BCBSLA using the following information:

  • Fax: 225.297.2750
  • E-mail: Network.Administration@bcbsla.com
  • Mail: Blue Cross Blue Shield of Louisiana
    Attn: Network Administration
    P.O. Box 98029
    Baton Rouge, LA 70898

The BCBSLA Network Operations Department only provides recredentialing status updates to the provider in question. To check the status of an application, or for additional information call 1.800.716.2299, option 3.