Credentialing

For Facilities

To Request Network Participation

Credentialing Criteria

Facilities at minimum must meet the criteria listed below:

  • Valid license, as applicable to type of facility
  • Professional Malpractice Liability Insurance certificate(s)
  • Accreditation certificate, as applicable (BCBSLA requires certain facility types to be accredited, in some instances a site visit may be allowed in lieu of accreditation)
  • OptiNet score of 80 percent or higher for each modality performed. This applies to Diagnostic Radiology providers, Acute Care Hospitals and Charity Hospitals only.
  • Signed and dated attestation/release to obtain primary source verification for the organization

Required Application

If you wish to become a participating facility in one of our networks and you meet minimum criteria then you should submit a Health Delivery Organization (HDO) Information Form.  If the provider does not meet basic criteria, the HDO form will be returned with an explanation and instructions for reapplying when applicable.

Required Supporting Documentation*

If you meet the above criteria, you must submit current copies of the following documents as applicable:

  • Current state license, as applicable
  • Signed and dated attestation/release to obtain primary source verification for the organization
  • Occupational or Operational license, as applicable
  • Accreditation certificate, as applicable (BCBSLA requires certain facility types to be accredited, in some instances a site visit maybe allowed in lieu of accreditation)
  • Professional Malpractice Liability Insurance certificate(s) and/or Louisiana Patient's Compensation Fund participation
  • CLIA certificate, as applicable
  • Employer Identification Number (EIN) Letter
  • Electronic Funds Transfer (EFT) application and a copy of a preprinted voided check.  See our EFT page.
  • iLinkBLUE and Business Associate Agreements appropriate for your practice.  See our iLinkBLUE page.
  • Provider Network Agreements, as applicable. If you are interested in network participation and you did not receive agreements, you may call Network Operations at 1.800.716.2299, option 3 to have the appropriate agreements sent to you.
  • W-9 Form

One of the following attachments is required based on the facility type:

All information submitted must be legible, current and without restriction.  We will return all submitted information to the provider if the HDO Form is not signed and dated.  Signature and date must be original.  Signature stamps or date stamps are not acceptable.

* This information varies for recredentialing. View the Facility Recredentialing page to find out more.

The credentialing process can take 60-90 days from receipt of the HDO Form.  Acceptance of the HDO Form is not a guarantee that the provider will be accepted in any network.  Providers will remain non-participating in our networks until their HDO Form has been approved by the Credentialing Subcommittee.  We will not allow a provider to participate in any network until their credentials have been approved by the Credentialing Subcommittee.  We do not back date network participation prior to the approval date.  The credentialing approval date becomes the effective date of network participation unless a future date is requested.  All HDO Forms must not be older than 180 days at the time of the Credentialing Subcommittee meeting.

Providers may appeal subcommittee decisions using the guidelines on the Appeals and Terminations page.

Applicable Organizations

BCBSLA reviews our contracted health delivery organizations as required by regulatory agencies. This policy applies to:

  • Alcohol/Drug Rehabilitation Centers
  • Ambulance Companies
  • Ambulatory Surgical Centers
  • Comprehensive Outpatient Rehabilitation Facilities
  • Durable Medical Equipment Suppliers
  • Federally Qualified Rural Health Clinics
  • Home Health Agencies
  • Home Infusion Centers
  • Hospice Centers
  • Hospitals
  • Independent Laboratories
  • Lithotripsy Facilities
  • Long-term Acute Care Centers
  • Psychiatric Hospitals
  • Radiology Centers
  • Rehabilitation Centers
  • Renal Dialysis Centers (free-standing)
  • Skilled Nursing Facilities
  • State-owned Psychiatric Hospitals, Laboratory and Diagnostic Centers
  • Urgent Care Centers

Submission

You may fax, e-mail or mail your HDO Form and supporting documents to BCBSLA using the following information.  Please use the mail option only when including agreements, as they are too large to send through the fax/e-mail option.

  • 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 provides credentialing status updates only to the facility in question.  To check the status of an application, questions regarding network participation or for any other additional information call 1.800.716.2299, option 3.