Credentialing

For Facilities

To Request A Provider Number ONLY (does not include network participation)

Please complete the Health Delivery Organization (HDO) Information Form and attach a copy of the required supporting documentation listed below.  Signature and date must be original.  Signature stamps or date stamps are not acceptable.

Provider Record Set-up Criteria

• Valid license, as applicable to type of facility
• Signed and dated attestation/release to obtain primary source verification for the organization

Required Supporting Documentation

• Valid state license, as applicable
• Occupational or Operational license, as applicable
• CLIA certificate, as applicable
• Employer Identification Number (EIN) Letter

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

• HDO Attachment A: Ambulance Company
• HDO Attachment B: DME Supplier or Pharmacy
• HDO Attachment C: Hospital or Ambulatory Surgical Center
• HDO Attachment D: Urgent Care Clinic / Walk-In Clinic
• HDO Attachment E: Diagnostic Radiology (Free-standing)
• HDO Attachment F: Retail Health Clinics

Submission

You may fax, e-mail or mail your HDO Form 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 application status updates to the facility in question.  To check the status of an application or for additional information call 1.800.716.2299 option 3. 

If you are interested in joining our networks, please visit our Facility Network Participation page.