Primary and Secondary Verification
Once the credentialing or recredentialing application and all supporting documentation are received and deemed complete, the primary and secondary verification begins. Verification is performed in the following areas, as applicable, by specialty:
- State Professional Licensing Board
Ensures license is current and in good standing and provides disciplinary actions from various agencies and states
- National Practitioner Data Bank
Medicare/Medicaid sanctions, malpractice claims history that have resulted in settlements or judgments and State/Federal Disciplinary Actions
- Clinical Privileges
Admitting clinical privileges confirmed at a BCBSLA participating hospital, as applicable by specialty
- American Board of Medical Specialties, as applicable
Verified if provider is board certified (or has become certified/re-certified since the last credentialing cycle), even if not practicing in that specialty
- Education/Residency (does not apply to recredentialing)
If the provider is not Board Certified, verification is attained from the highest level of training. Board Certification fully meets this standard.
- Work History
Past five years accounted for by provider (Past three years for recredentialing)
- Malpractice Insurance (General policy & LPCF participation)
Face Sheet current and within limitations
- Louisiana Controlled Dangerous Substance (CDS) License and Federal DEA Certificate
Copy of current, legible license
Further Review
The Medical Director reviews files with significant malpractice and/or disciplinary actions. He assures enough details have been collected. After verification, the provider's file may 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.
The BCBSLA Network Operations Department only provides credentialing status updates to the physician in question. To check the status of an application, or for additional information call 1.800.716.2299, option 3.
