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 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.
(As applicable by specialty)
Providers will be notified eight months prior to the recredentialing deadline date to ensure ample time is allowed for verification.
The provider must submit the 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.
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.
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.
Providers are not required to be recredentialed due to an address change.
You may fax, e-mail or mail your application and supporting documents to Blue Cross using the following information:
The Blue Cross 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.
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