Board Certified & Non-Board Certified:
- Doctor of Dental Surgery
- Doctor of Maxillofacial Surgery
- Doctor of Medical Dentistry
- Doctor of Osteopathy
- Doctor of Podiatry
- Medical Doctor
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Provider application (credentialing + enrollment)
Step 1 of 4
Get credentialed with CAQH Provider Data Portal
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) credentials all practitioners of care, ancillary and facility providers applying for membership in the network(s).
All providers and facilities in our network need to be recredentialed every three years.
Step 2 of 4
Email Blue Cross NC with CAQH ID #
Send an email to credentialing@bcbsnc.com with your CAQH ID number. Make sure you've completed your CAQH application before emailing us. We'll start reviewing once we receive your email.
Step 3 of 4
Complete and email taxpayer W-9 ID form to Blue Cross NC
Providers joining our network must complete a W-9 taxpayer ID form. Use this instructional guide for help (PDF).
Once finished, email form to ProvRequests@bcbsnc.com.
Step 4 of 4
Register your NPI number
Providers need to register their NPI number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered. Only providers with a Blue Cross NC contract can receive direct payment.
Have you already registered your NPI?
If you are an out-of-network provider who previously received payment for services from Blue Cross NC, you have already registered your NPI with us. You will need to contact Blue Cross NC Provider Service at 800-777-1643. Choose option 6 to continue the enrollment process.
Use this instructional guide for help (PDF) completing the taxpayer W-9 form.
Providers who want to contract with Blue Cross NC
Before we begin, you will need to sign up for our provider portal and electronic payment
Once you have become credentialed and enrolled with your registered NPI number and tax ID, you will need to sign up for Blue e and electronic funds transfer (EFT) payment.
Blue Cross NC requires participating providers to file claims electronically and receive electronic funds transfers.
Finalizing your network participation
After you have received confirmation of credentialing, enrollment, Blue e, and EFT, you will receive a network participation agreement within 45 days. If you do not receive this agreement within 45 days, please call us at 800-777-1646, option 6.
Step 1 of 1
Register your NPI number for payment
Providers need to register their NPI number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered.
Use this instructional guide for help (PDF) completing the taxpayer W-9 form.
Step 1 of 1
Get recredentialed with CAQH Provider Data Portal
Blue Cross NC credentials all practitioners of care, ancillary and facility providers applying for membership in the network(s).
All providers and facilities in our network need to be recredentialed every three years.
Facilities application (credentialing + enrollment)
Step 1 of 4
Select facility type and review requirements
Each facility type requires specific criteria and documents you will need to submit along with your application to be considered for credentialing. Select your facility type from the list to view the documents you will need to submit. Then move on to step 2.
Please include the following documents with your application:
- A copy of a North Carolina license
- Proof of Medicare certification
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence / $3 million aggregate) or letter attesting to all covered sites.
Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS) – we will accept a site survey conducted within the past 3 years.
Please include the cover letter and follow-up letter (if applicable):
- One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:
- The Joint Commission (TJC)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
- Note: A current one page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- On the application form, if the facility answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
- Number of cases less than $200,000
- If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
- Ambulatory Surgical Centers must be accredited. One of the following accreditation certificates is required:
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- Accreditation Association for Ambulatory Health Care, Inc. (AAAHC)
- American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
- A copy of the Division of Facility Services License is required for each site (or letter attesting to all covered sites).
- Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
- Birthing Centers must be accredited. One of the following accreditation certificates is needed:
- The Joint Commission (TJC)
- Accreditation Association for Ambulatory Health Care, Inc. (AAAHC)
- Critical Access Certification for hospitals
- Commission for the Accreditation of Birth Centers
- A copy of the Division of Health Services regulation license is required for each site (or letter attesting to all covered sites) if applicable
- A general liability insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- A copy of the policy and procedure for coverage arrangements with a participating provider and hospital, in the event of an emergency situation is required.
Please include the following documents with your application:
- Dialysis Facilities must be either accredited or certified by Centers for Medicare and Medicaid (CMS). One of the following accreditation certificates is needed (if applicable):
- The Joint Commission (TJC)
- Accreditation Association for Ambulatory Health Care (AAAHC)
- National Dialysis Accreditation Commission (NDAC)
- A current copy of the Division of Health Service Regulation / ESRD Facility Survey Report
- Medicare verification is needed (if applicable)
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- In the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
- Number of cases less than $200,000
- If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case
- A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) / ACR (American College of Radiology) must be in all provider files
- A copy of the current Utilization Management Program
- A copy of the current Quality Management (Quality Assurance) Program
- A copy of the current Infection Control Plan to include infection rates and transfers from the Dialysis Center(s) to Acute Care Centers
- A copy of all current services provided at the facility
- A copy of the facility's one year of quarterly reporting of quality outcomes data for the following K / Dialysis Outcome Quality Initiative Indicators (K / DOQI):
- Urea Reduction Ration (URR) = 65%
- Urea Kinetic Modeling (Kt / V) = 1.2 Kt / V delivered vs. prescribed dose
- Hemoglobin of 11-12 grams
- Hematocrit > 33% for premenopausal females and pre pubertal patients and 37% for adult males and postmenopausal females
- Albumin of 3.5 to 5.2
- Note: 80% of all patients must meet the K / DOQI measures
Please include the following documents with your application:
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Non accredited Pharmacies must submit exemption letter from Medicare.
One of the following accreditation certificates is needed if no exemption letter from Medicare:
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc's "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification/Accreditation International (BOC)
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- Completed application
- Facility based crisis centers must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A copy of a NC Department of facility services license for (Facility Based Crisis Service for Individuals of all Disability Groups, License .5000)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Blue Medicare HMO and Blue Medicare PPO networks only.
Please include the following documents with your application:
A copy of a NC license or Certificate of Need (if applicable per state or federal regulatory requirements)
One of the following accreditation certificates is required:
American College of Radiology (ACR)
Inter-societal Accreditation Commission (IAC)
The Joint Commission (TJC)
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence / $3 million aggregate) or letter attesting to all covered sites.
Includes all Home Durable Medical Equipment which includes equipment only and cardiac event monitoring only.
Please include the following documents with your application:
A copy of the North Carolina Division of Health Service Regulation or North Carolina Board of Pharmacy Permit-Devise Dispensing Permit, Board of Pharmacy Permit-Devise and Medical Equipment
One of the following documents is needed:
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification / Accreditation International (BOC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
Home Health Agencies must be accredited. One of the following accreditation certificates or letter attesting to all covered sites is required for each site:
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
All of the following services must be provided in order to meet contracting requirements:
Skilled Nursing Visits
Speech Therapy
Physical Therapy
Home Health Aide
Occupational Therapy
Medical Social Services
A copy of the Division of Health Service Regulation license is required for each site
Medicare verification is needed (if applicable)
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate. General liability insurance face sheet must indicate practice / provider address.
Please include the following documents with your application:
All of the following services must be provided in order to meet contracting requirements:
Pharmacy
Nursing
Supplies
A copy of the Division of Health Service Regulation License and Board of Pharmacy Permit-Infusion Services is required for each site.
Home Infusion Agencies must be accredited.
One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites):
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
Hospice must be accredited. One of the following accreditation certificates (or letter attesting to all covered sites) is required for each site:
The Joint Commission (TJC)
Accreditation Commission for Health Care (ACHC)
A copy of the Division of Health Service Regulation license is required for each site.
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
Hospitals must be accredited. One of the following accreditation certificates is required:
Commission on Accreditation of Rehabilitation Facilities (CARF)
The Joint Commission (TJC)
National Integrated Accreditation for Healthcare Organizations (NIAHO)
A copy of the Division of Health Service Regulation license is required for each site (or letter attesting to all covered sites).
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
For cardiac event monitoring services within Blue Medicare HMO and Blue Medicare PPO networks only
Please include the following documents with your application:
A copy of the CLIA Full (Level 3) certification or registration (Clinical Laboratory Improvement Amendments) if applicable
Accreditation by College of American Pathologists (CAP) or Commission on Office Laboratory Accreditation (COLA), American College of Radiology (ACR), or The Joint Commission (TJC)
Medicare certification is required:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence / $3 million aggregate) or letter attesting to all covered sites.
- Completed Application
- General Psychiatric IOP
- a copy of a NC Department of facility services license: (Day Activity for Individuals of All Disability Groups, License .5400)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Substance Use Disorder IOP
- a copy of a NC Department of facility services license: (Substance Abuse Intensive Outpatient Program License .4400)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
One of the following accreditation certificates is needed (if applicable):
The Joint Commission (TJC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Accreditation Association for Ambulatory Health Care (AAAHC)
Council on Accreditation for children and family services (COA)
Community Health Accreditation Program (CHAP)
Continuing Care Accreditation Commission (CCAC)
A copy of a North Carolina Business license
Medicare verification:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
General liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate (or letter attesting to all covered sites).
In the application, if you've answered yes to any under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
- Complete Application
- Non-Hospital Medical Detox must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A copy of a NC Department of facility services license for (Non-hospital Medical Detoxification-Individuals who are Substance Abusers, License .3100)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
Division of Health Services Regulation License to provider Opioid Treatment
DEA
SAMSHSA Certification ("provisional" SAMSHSA Certification will not be excepted)
Letter of Certification from SAMSHSA
Medicare Provider Number
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
National Accreditation (CARF, Joint Commission, Council on Accreditation, and National Commission on Correctional Health Care)
General and Professional Liability. It must include current coverage dates, facility name, facility address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Contracting requirements are listed below:
- Methadone Treatment
- Individual psychotherapy
- Buprenorphine / Naloxone Treatment
- Intensive Outpatient Treatment
- Family Psychotherapy
- Group Psychotherapy
- Psychiatric Evaluation
This includes all Orthotics and Prosthetics which will include Breast Prosthetics only.
Please include the following documents with your application:
One of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification / Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (TJC)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- Substance Abuse Comprehensive Outpatient Treatment Program (SACOT)
- A copy of a NC Department of facility services license: (Substance Abuse Comprehensive Outpatient Treatment (SACOT), License .4500)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Medicare verification is needed (if applicable).
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- Partial Hospitalization for Individuals who are Acutely Mentally Ill
- A copy of a NC Department of facility services license: (Partial Hospitalization for Individuals who are Acutely Mentally Ill, License .1100)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Medicare verification is needed (if applicable).
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Please include the following documents with your application:
- Private Duty Nursing must be accredited. One of the following accreditation certificates (or a letter attesting to all covered sites) is required for each site:
- The Joint Commission (TJC)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- A copy of the Division of Health Service Regulation license is required for each site.
- Medicare verification is needed (if applicable).
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
- CLIA certificate Full (Level 3)
- Accreditation by College of American Pathologists (CAP) or Commission on Office Laboratory Accreditation (COLA) or The Joint Commission (TJC)
- If not accredited by an accrediting agency (CAP, COLA, or TJC) needs CMS site survey
- Medicare certification
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
- Residential Treatment / Rehabilitation for Individuals with Substance Abuse Disorders
- A copy of a NC Department of facility services license (Residential Treatment / Rehabilitation for Individuals with Substance Abuse Disorders, License .3400)
- An accreditation certificate or current NC State Site Survey / Statements of Deficiencies (SOD) is required.
- We accept accreditation from the following:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Psychiatric Residential Treatment for Children and Adolescents
- A copy of a NC Department of facility services license (Psychiatric Residential Treatment Facility for children and adolescents, License .1900)
- An accreditation certificate or current NC State Site Survey / Statements of Deficiencies (SOD) is required.
- We accept accreditation from the following:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Psychiatric Residential Treatment for Adults
- A copy of a NC Department of facility services license (Supervised Living for Adults with Mental Illness, License .5600A)
- An accreditation certificate or current NC State Site Survey / Statements of Deficiencies (SOD) is required.
- We accept accreditation from the following:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
If not accredited, please provide a copy of the most recent CMS Review.
If you are qualified and enrolled with the National Supplier Clearinghouse as a Medicare certified DMEPOS supplier one of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification / Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (TJC)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Copy of the Division of Health Service Regulation license
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Medicare verification is required for each site (or letter attesting to all covered sites).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
On the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Medicare certification is required (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
One of the following accreditation certificates is needed (if applicable):
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
International Standards Organization (ISO)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
American Academy of Sleep Medicine
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
Board of Pharmacy Permit-Devise and Medical Equipment Permit is required
Medicare certification is required.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) if applicable.
Accreditation by URAC
In lieu of the Accreditation by URAC, we can accept pharmacies that have received federal designation as a Hemophilia Treatment Center
Step 2 of 4
Complete and submit facility credentialing form
Download and complete the PDF form. Then email your documents from steps 1 and 2 to credentialing@bcbsnc.com.
Step 3 of 4
Complete and email taxpayer W-9 ID form to Blue Cross NC
Providers and facilities joining our network must complete a W-9 taxpayer ID form. Use this instructional guide for help (PDF).
Once finished, email form to ProvRequests@bcbsnc.com.
Step 4 of 4
Register your NPI type II number
Facilities need to register their NPI type II number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered. Only providers with a Blue Cross NC contract can receive direct payment.
Have you already registered your NPI?
If you are an out-of-network provider who previously received payment for services from Blue Cross NC, you have already registered your NPI with us. You will need to contact Blue Cross NC Provider Service at 800-777-1643, choose option 6 to continue the enrollment process.
Facilities that want to contract with Blue Cross NC
Before we begin, you will need to sign up for our provider portal and electronic payment
Once you have become credentialed and enrolled with your registered NPI number and tax ID, you will need to sign up for Blue e and electronic funds transfer (EFT) payment.
Blue Cross NC requires participating providers to file claims electronically and receive electronic funds transfers.
Finalizing your network participation
After you have received confirmation of credentialing, enrollment, Blue e, and EFT, you will receive a network participation agreement within 45 days. If you do not receive this agreement within 45 days, please call us at 800-777-1646, option 6.
Step 1 of 1
Register your NPI type II number for payment
Facilities need to register their NPI type II number to submit claims and receive direct payment to their bank account through electronic funds transfer (EFT). However, direct payment is not guaranteed even if the NPI is registered.
Step 1 of 2
Select facility type and review requirements
Each facility type requires specific criteria and documents you will need to submit along with your application to be considered for credentialing. Select your facility type from the list to view the documents you will need to submit. Then move on to step 2.
Please include the following documents with your application:
- A copy of a North Carolina license
- Proof of Medicare certification
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence / $3 million aggregate) or letter attesting to all covered sites.
Infusion Agencies must be either accredited or certified by Centers for Medicare and Medicaid (CMS) – we will accept a site survey conducted within the past 3 years.
Please include the cover letter and follow-up letter (if applicable):
- One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites) if applicable:
- The Joint Commission (TJC)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
- Note: A current one page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- On the application form, if the facility answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
- Number of cases less than $200,000
- If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
- Ambulatory Surgical Centers must be accredited. One of the following accreditation certificates is required:
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- Accreditation Association for Ambulatory Health Care, Inc. (AAAHC)
- American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
- A copy of the Division of Facility Services License is required for each site (or letter attesting to all covered sites).
- Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
- Birthing Centers must be accredited. One of the following accreditation certificates is needed:
- The Joint Commission (TJC)
- Accreditation Association for Ambulatory Health Care, Inc. (AAAHC)
- Critical Access Certification for hospitals
- Commission for the Accreditation of Birth Centers
- A copy of the Division of Health Services regulation license is required for each site (or letter attesting to all covered sites) if applicable
- A general liability insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- A copy of the policy and procedure for coverage arrangements with a participating provider and hospital, in the event of an emergency situation is required.
Please include the following documents with your application:
- Dialysis Facilities must be either accredited or certified by Centers for Medicare and Medicaid (CMS). One of the following accreditation certificates is needed (if applicable):
- The Joint Commission (TJC)
- Accreditation Association for Ambulatory Health Care (AAAHC)
- National Dialysis Accreditation Commission (NDAC)
- A current copy of the Division of Health Service Regulation / ESRD Facility Survey Report
- Medicare verification is needed (if applicable)
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- In the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
- Number of cases less than $200,000
- If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case
- A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) / ACR (American College of Radiology) must be in all provider files
- A copy of the current Utilization Management Program
- A copy of the current Quality Management (Quality Assurance) Program
- A copy of the current Infection Control Plan to include infection rates and transfers from the Dialysis Center(s) to Acute Care Centers
- A copy of all current services provided at the facility
- A copy of the facility's one year of quarterly reporting of quality outcomes data for the following K / Dialysis Outcome Quality Initiative Indicators (K / DOQI):
- Urea Reduction Ration (URR) = 65%
- Urea Kinetic Modeling (Kt / V) = 1.2 Kt / V delivered vs. prescribed dose
- Hemoglobin of 11-12 grams
- Hematocrit > 33% for premenopausal females and pre pubertal patients and 37% for adult males and postmenopausal females
- Albumin of 3.5 to 5.2
- Note: 80% of all patients must meet the K / DOQI measures
Please include the following documents with your application:
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Non accredited Pharmacies must submit exemption letter from Medicare.
One of the following accreditation certificates is needed if no exemption letter from Medicare:
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc's "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification/Accreditation International (BOC)
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- Completed application
- Facility based crisis centers must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A copy of a NC Department of facility services license for (Facility Based Crisis Service for Individuals of all Disability Groups, License .5000)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Blue Medicare HMO and Blue Medicare PPO networks only.
Please include the following documents with your application:
A copy of a NC license or Certificate of Need (if applicable per state or federal regulatory requirements)
One of the following accreditation certificates is required:
American College of Radiology (ACR)
Inter-societal Accreditation Commission (IAC)
The Joint Commission (TJC)
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence / $3 million aggregate) or letter attesting to all covered sites.
Includes all Home Durable Medical Equipment which includes equipment only and cardiac event monitoring only.
Please include the following documents with your application:
A copy of the North Carolina Division of Health Service Regulation or North Carolina Board of Pharmacy Permit-Devise Dispensing Permit, Board of Pharmacy Permit-Devise and Medical Equipment
One of the following documents is needed:
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
Commission on Accreditation of Rehabilitation Facilities (CARF)
Healthcare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
American Board of Certification in Orthotics and Prosthetics (ABC)
Board of Certification / Accreditation International (BOC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
Home Health Agencies must be accredited. One of the following accreditation certificates or letter attesting to all covered sites is required for each site:
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
All of the following services must be provided in order to meet contracting requirements:
Skilled Nursing Visits
Speech Therapy
Physical Therapy
Home Health Aide
Occupational Therapy
Medical Social Services
A copy of the Division of Health Service Regulation license is required for each site
Medicare verification is needed (if applicable)
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate. General liability insurance face sheet must indicate practice / provider address.
Please include the following documents with your application:
All of the following services must be provided in order to meet contracting requirements:
Pharmacy
Nursing
Supplies
A copy of the Division of Health Service Regulation License and Board of Pharmacy Permit-Infusion Services is required for each site.
Home Infusion Agencies must be accredited.
One of the following accreditation certificates is needed for each site (or letter attesting to all covered sites):
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
Hospice must be accredited. One of the following accreditation certificates (or letter attesting to all covered sites) is required for each site:
The Joint Commission (TJC)
Accreditation Commission for Health Care (ACHC)
A copy of the Division of Health Service Regulation license is required for each site.
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
Hospitals must be accredited. One of the following accreditation certificates is required:
Commission on Accreditation of Rehabilitation Facilities (CARF)
The Joint Commission (TJC)
National Integrated Accreditation for Healthcare Organizations (NIAHO)
A copy of the Division of Health Service Regulation license is required for each site (or letter attesting to all covered sites).
Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet for each site (or letter attesting to all covered sites). It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
For cardiac event monitoring services within Blue Medicare HMO and Blue Medicare PPO networks only
Please include the following documents with your application:
A copy of the CLIA Full (Level 3) certification or registration (Clinical Laboratory Improvement Amendments) if applicable
Accreditation by College of American Pathologists (CAP) or Commission on Office Laboratory Accreditation COLA, American College of Radiology (ACR), or The Joint Commission (TJC)
Medicare certification is required:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage ($1 million per occurrence / $3 million aggregate) or letter attesting to all covered sites.
- Completed Application
- General Psychiatric IOP
- a copy of a NC Department of facility services license: (Day Activity for Individuals of All Disability Groups, License .5400)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Substance Use Disorder IOP
- a copy of a NC Department of facility services license: (Substance Abuse Intensive Outpatient Program License .4400)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
One of the following accreditation certificates is needed (if applicable):
The Joint Commission (TJC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Accreditation Association for Ambulatory Health Care (AAAHC)
Council on Accreditation for children and family services (COA)
Community Health Accreditation Program (CHAP)
Continuing Care Accreditation Commission (CCAC)
A copy of a North Carolina Business license
Medicare verification:
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
General liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate (or letter attesting to all covered sites).
In the application, if you've answered yes to any under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
- Complete Application
- Non-Hospital Medical Detox must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A copy of a NC Department of facility services license for (Non-hospital Medical Detoxification-Individuals who are Substance Abusers, License .3100)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
Division of Health Services Regulation License to provider Opioid Treatment
DEA
SAMSHSA Certification ("provisional" SAMSHSA Certification will not be excepted)
Letter of Certification from SAMSHSA
Medicare Provider Number
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
National Accreditation (CARF, Joint Commission, Council on Accreditation, and National Commission on Correctional Health Care)
General and Professional Liability. It must include current coverage dates, facility name, facility address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Contracting requirements are listed below:
- Methadone Treatment
- Individual psychotherapy
- Buprenorphine / Naloxone Treatment
- Intensive Outpatient Treatment
- Family Psychotherapy
- Group Psychotherapy
- Psychiatric Evaluation
This includes all Orthotics and Prosthetics which will include Breast Prosthetics only.
Please include the following documents with your application:
One of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification / Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (TJC)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Medicare verification is needed (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
- Substance Abuse Comprehensive Outpatient Treatment Program (SACOT)
- A copy of a NC Department of facility services license: (Substance Abuse Comprehensive Outpatient Treatment (SACOT), License .4500)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Medicare verification is needed (if applicable).
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- Partial Hospitalization for Individuals who are Acutely Mentally Ill
- A copy of a NC Department of facility services license: (Partial Hospitalization for Individuals who are Acutely Mentally Ill, License .1100)
- Must be accredited by one of the following accreditation bodies for the appropriate services:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Medicare verification is needed (if applicable).
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
Please include the following documents with your application:
- Private Duty Nursing must be accredited. One of the following accreditation certificates (or a letter attesting to all covered sites) is required for each site:
- The Joint Commission (TJC)
- The Community Accreditation Program, Inc. (CHAP)
- Accreditation Commission for Health Care (ACHC)
- A copy of the Division of Health Service Regulation license is required for each site.
- Medicare verification is needed (if applicable).
- Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
- Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
- A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
CLIA certificate Full (Level 3)
Accreditation by College of American Pathologists (CAP) or Commission on Office Laboratory Accreditation COLA (if applicable)
If not accredited by an accrediting agency (CAP or COLA) needs CMS site survey
Medicare certification
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Please include the following documents with your application:
- Residential Treatment / Rehabilitation for Individuals with Substance Abuse Disorders
- A copy of a NC Department of facility services license (Residential Treatment / Rehabilitation for Individuals with Substance Abuse Disorders, License .3400)
- An accreditation certificate or current NC State Site Survey / Statements of Deficiencies (SOD) is required.
- We accept accreditation from the following:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Psychiatric Residential Treatment for Children and Adolescents
- A copy of a NC Department of facility services license (Psychiatric Residential Treatment Facility for children and adolescents, License .1900)
- An accreditation certificate or current NC State Site Survey / Statements of Deficiencies (SOD) is required.
- We accept accreditation from the following:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
- Psychiatric Residential Treatment for Adults
- A copy of a NC Department of facility services license (Supervised Living for Adults with Mental Illness, License .5600A)
- An accreditation certificate or current NC State Site Survey / Statements of Deficiencies (SOD) is required.
- We accept accreditation from the following:
- The Joint Commission (TJC)
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- A general liability insurance face sheet is required and must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
If not accredited, please provide a copy of the most recent CMS Review.
If you are qualified and enrolled with the National Supplier Clearinghouse as a Medicare certified DMEPOS supplier one of the following accreditation certificates is needed:
The American Board of Certification (ABC)
The Board of Certification / Accreditation International (BOC)
Commission on Accreditation of Rehabilitation Facilities (CARF)
Community Health Accreditation Program (CHAP)
HealthCare Quality Association on Accreditation (HQAA)
National Association of Boards of Pharmacy (NABP)
The Joint Commission (TJC)
The Compliance Team, Inc.
The National Board of Accreditation for Orthotic Suppliers (NBAOS)
Accreditation Commission for Health Care, Inc. (ACHC)
Copy of the Division of Health Service Regulation license
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, and limits of coverage. Minimum coverage for all networks is $1 million per occurrence / $3 million aggregate.
Medicare verification is required for each site (or letter attesting to all covered sites).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
On the application, if you've answered yes to any questions under section 1.G, an explanation is needed. The following information is required if question number C is answered yes:
Number of cases less than $200,000
If greater than $200,000 actual or anticipated, include the occurrence date, settlement date, and nature of case.
Please include the following documents with your application:
Medicare certification is required (if applicable).
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
One of the following accreditation certificates is needed (if applicable):
The Joint Commission (TJC)
The Community Accreditation Program, Inc. (CHAP)
Accreditation Commission for Health Care (ACHC)
International Standards Organization (ISO)
The Compliance Team Inc.'s "Exemplary Provider Award Program"
American Academy of Sleep Medicine
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
Please include the following documents with your application:
Board of Pharmacy Permit-Devise and Medical Equipment Permit is required
Medicare certification is required.
Note: Medicare verification is needed for each site (or letter attesting to all covered sites) if applicable. A current one-page copy of a Medicare Remittance Advice Summary (RA) from the facility, no older than 3–6 months with PHI redacted, will meet this requirement.
Note: If applying for the Blue Medicare HMO and Blue Medicare PPO networks, Medicare certification is required.
A general liability malpractice insurance face sheet. It must include current coverage dates, provider name, address, or letter attesting to all covered sites, and limits of coverage ($1 million per occurrence / $3 million aggregate).
A copy of the CLIA certification or registration (Clinical Laboratory Improvement Amendments) if applicable.
Accreditation by URAC
In lieu of the Accreditation by URAC, we can accept pharmacies that have received federal designation as a Hemophilia Treatment Center
Step 2 of 2
Complete and submit facility recredentialing form
Download and complete the PDF form. Then email your application along with the documents from step 1 to credentialing@bcbsnc.com.
Credentialing rights and requirements
Other:
- Advanced Practice Nurse
- Audiologist
- Board Certified Behavior Analyst
- Certified Substance Abuse Counselor
- Chiropractor
- Doctor of Dental Science
- Doctor of Optometry
- Hearing Aid Fitter
- Licensed Certified Social Worker
- Licensed Clinical Addiction Specialist
- Licensed Clinical Social Worker Associate
- Licensed Dietitian Nutritionist
- Licensed Marriage and Family Therapist
- Licensed Marriage and Family Therapist Associates
- Licensed Pastoral Counselor
- Licensed Professional Counselor
- Licensed Professional Counselor Associate
- Licensed Psychological Associate
- Occupational Therapist
- Pharmacist
- Physical Therapist
- Physician Assistant
- Psychiatric Nurse
- Psychologist
- Respiratory Therapist
- Speech Pathologist
- Ambulance
- Ambulatory Surgical Center
- Birthing Center
- Independent Diagnostic Testing Facility
- Dialysis Facility
- Durable Medical Equipment (Diabetic Supplies Only)
- Free Standing Radiology
- Home Durable Medical Equipment
- Home Health Agency
- Home Infusion Therapy
- Hospice Agency
- Hospital
- Intensive Outpatient Facility
- Mobile X-ray (Blue Medicare HMO and Blue Medicare PPO networks only)
- Opioid Treatment Centers
- Orthotics and Prosthetics
- Partial Hospitalization
- Private Duty Nursing
- Reference Laboratory
- Residential Treatment Facility
- Skilled Nursing Facility
- Sleep Center
- Specialty Pharmacy
Optometry and Ophthalmology commercial networks are closed in all counties. Optometrist and ophthalmologist participation for routine vision is managed by Community Eye Care (CEC). Contact CEC for participation inquiries and to initiate credentialing and/or recredentialing by email at providers@cecvision.com and by phone (CEC 888-254-4290).
Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.
All practitioners applying for credentialing and recredentialing have the following rights:
- To review information submitted to support their credentialing application
- To correct erroneous information within 45 days from the notification
- To be informed, upon request, of the status of their credentialing or recredentialing application
- To be notified verbally or in writing of any information obtained during the organization’s credentialing process that varies substantially from the information provided to the organization by the practitioner
Credentialing/recredentialing updates
Board Certification Criteria
- MD/DOs must be board certified. An MD/DO that is Board Eligible may apply for credentialing with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) networks with the express condition that they must become Board Certified by American Board of Medical Specialties (ABMS) or American Board of Osteopathic Association (AOA) or American Board of Foot and Ankle Surgery (ABFAS) or American Board of Podiatric Medicine (ABPM) or American Board of Oral and Maxillofacial Surgery within three (3) years from their initial credentialing date.
- MD/DOs will be credentialed in the respective field in which they are Board Eligible/Certified to practice based on the application information submitted by the MD/DO.
- MD/DO with Board Eligibility in two (2) or more specialties may apply for credentialing with Blue Cross NC, with the express condition that they become Board Certified for each specialty they wish to participate with Blue Cross NC for within three (3) years of their initial credentialing by ABMS, AOA, ABFAS, ABPM, or ABOMS.
- All MD/DOs credentialed with Blue Cross NC April 30, 2023 or prior are grandfathered in for the board certification requirement. Nothing prohibits any Board Eligible MD/DO covered here from obtaining Board Certification and updating their Blue Cross NC file.
- Should any MD/DO currently grandfathered, terminate from the Blue Cross NC network for any reason and later reapply for credentialing, the MD/DO shall be treated as an initial practitioner credentialing, and the terms for initial credentialing shall apply.
- MDs and DOs meeting any one of the following criteria will be viewed as meeting the certification requirement:
- If Board eligibility requirements take longer than three (3) years for completion for all providers obtaining that Board certification. For example, but not limited to, certain fellowship training requiring longer than three (3) years, and foreign national physician candidates working towards Board certification.
- Previous board certification as defined by one of the following: ABMS, AOA, ABFAS, ABPM, or ABOMS in the clinical specialty or subspecialty for which they are applying which has now expired and a minimum of ten (10) consecutive years of clinical practice
- Training which met the requirements in place at the time it was completed in a specialty field prior to the availability of board certifications in that clinical specialty or subspecialty; or
- Specialized practice expertise as evidenced by publication in nationally accepted peer review literature and/or recognized as a leader in the science of their specialty and a faculty appointment of assistant professor or higher at an academic medical center and teaching facility in Blue Cross NC network and the applicant’s professional activities are spent at that institution at least fifty percent (50%) of the time in active clinical patient care.
- If provider does not meet the requirements outlined above, provider may submit an explanation for Blue Cross NC Credentialing Committee consideration.
Delegated Credentialing
- For existing delegated entities, as of 1/1/24, these criteria apply for any new providers joining the delegate.
- Any new delegated entity will be held to these criteria effective immediately.
All initial credentialing files for Physicians
- Any MD/DO that is Board Eligible may apply for Credentialing with Blue Cross NC Networks with the express understanding that they must become Board Certified by the time they recredential with Blue Cross NC Networks or within three (3) years.
- Should any MD/DO that was Board Eligible upon initial credentialing, fail to obtain their Board Certification on or before their recredentialing date, specifically within three (3) years, shall be immediately terminated.
- All other MD/DOs, that were Board Eligible upon initial credentialing, and obtained their Board Certification within the three (3) year deadline, shall be eligible for recredentialing within the Blue Cross NC Networks.
- All MD/DOs will be credentialed in the respective field they are Board Eligible/Certified in.
All recredentialed files for Physicians
- All MD/DOs that were Board Eligible and have already been credentialed with the Blue Cross NC Networks, on or before April 30, 2023, are officially grandfathered into the Blue Cross NC Networks and do not have to obtain their Board Certification. These Practitioners shall remain as Board Eligible unless they willingly obtain their Board Certification.
- Should any Recredentialed MD/DOs leave the Blue Cross NC Networks, and then return at a later date, shall be treated as an Initial Practitioner, and will be required to be Board Eligible and then obtain their Board Certification within the three (3) year credentialing cycle, in order to participate in the Blue Cross NC Networks.
Effective November 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin utilizing the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal (formerly known as CAQH ProView) universal credentialing application. The upcoming changes to our processes will improve quality and timeliness in onboarding our new providers/practitioners to Blue Cross NC. Providers will be required to do the following:
- Use CAQH Provider Data Portal for initial credentialing and recredentialing with Blue Cross NC.
- Complete the new online Individual Practitioner Enrollment Form for enrolling new practitioners
or
- Complete the online Provider Group Enrollment Form for enrolling new groups
- Submit individual practitioner and group enrollment forms 60 days prior to the provider’s effective date; as it currently takes 60 days for a new enrollment to be processed.
This initial step of integrating automation and streamlining onboarding processes will improve turnaround times for credentialing and enrollment.
We appreciate your cooperation and look forward to partnering with you as we transition to a more automated and digitized workflow. Please see the FAQ which provides further guidance and instructions for utilizing these electronic processes.
Reference Laboratory commercial networks are managed by Avalon Health Care Solutions. Please contact Avalon for participation inquiries by email at NetworkTeam@AvalonHCS.com.
Effective Oct. 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin using Verifide, a credentialing verification organization, to conduct primary source verification. Here’s what this means for you:
- Verifide uses the CAQH Provider Data Portal (Formerly CAQH ProView) credentialing database as part of their verification process. Therefore, all providers applying for Blue Cross NC credentialing and recredentialing must be registered in the CAQH Provider Data Portal.
- If you are not registered for CAQH Provider Data Portal and are seeking credentialing/recredentialing, please visit https://proview.caqh.org and click "register here" in option 3 under the "First Time Here?" section. If you have trouble registering, contact CAQH Provider Data Portal at 888-599-1771, Monday – Friday from 7 a.m. - 8 p.m. (ET), or use the chat portal on the website. You also should complete your profile and attestation once you're registered.
- If you are already registered for the CAQH Provider Data Portal, you do not need to take any action. Verifide will contact you if they need additional or updated information for primary source verification. Additionally, you should continue your usual process of attesting every 120 days that your information is accurate in the CAQH Provider Data Portal database.
- Recredentialing will be delayed until provider information is complete and updated in the CAQH Provider Data Portal database.
If you have questions, contact Provider Services at 800-777-1643, option 6.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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