Recredentialing

For Facilities

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

Recredentialing Criteria

(As applicable)

Facilities at minimum must continue to meet 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

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

The facility may make any necessary updates or changes to the information printed on the application. Facility must submit the preprinted application completed, signed and dated, along with the required documentation listed below. We will return all submitted information to the facility 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
In order to meet the criteria above, you must submit current copies of the following documents as applicable:

  • Valid State license
  • Occupational or Operational license
  • Professional Malpractice Liability Insurance certificate(s) and/or Louisiana Patient's Compensation Fund (LPCF) participation
  • Accreditation certificate, as applicable
  • CLIA certificate, as applicable

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

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

Relocation

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

  • Systems will generally be updated within 14 days after receiving new address information
  • There will be no disruption to the facility's network participation due to an address change

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 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 facility in question.  To check the status of an application, or for additional information call 1.800.716.2299, option 3.