Blue Cross Blue Shield of Texas - Option 2 - Credentialing for Network Participation

Option 2 - Credentialing for Network Participation

To become a participating physician or other professional provider, you will need to complete a two-step process.

Step 1: Establish a BCBSTX provider record (refer to Option 1)
Step 2: Submit a fully completed TDI Standardized Credentialing Application Packet and all applicable attachments.

BCBSTX requires full credentialing of all physicians and other professional providers for their managed care networks. BCBSTX will provide an expedited credentialing process which allows for a "provisional network participation" status if the provider applicant

1) has a valid license in the state by, and in good standing with, the Texas Licensing Boards,

2) submits all documentation required to make an application complete, and

3) submits a current signed contract/agreement.

If BCBSTX is unable to verify license information, the applicant will be fully credentialed and made effective after credentialing approval.

If you are one of the following provider types that BCBSTX contracts with and would like to become a participating physician or other professional provider, submission of a fully completed Texas Standardized Credentialing Application packet is required.

MDs and DOs
DDSs (oral and maxillofacial surgery)
Licensed Physical Therapists, Occupational Therapists
Optometrists, Audiologists, Speech and Language Pathologists
Behavioral Health Providers*
Physician Assistants, Surgical Assistants, Advanced Practice Nurses, Certified Midwives, Registered Nurse First Assistants
Podiatrists
Chiropractors
Acupuncturists
Certified Registered Nurse Anesthetists

All applicants should utilize the TDI Credentialing Application Completion Guide to verify that they are submitting a fully completed application packet. Incomplete application packets will be returned.

Texas Standardized Credentialing Application (pages 1-20) and all applicable attachments. (CAQH Users, please contact CAQH for instructions in downloading your information to the TDI Credentialing application)
Behavioral Health Form – required to be submitted in conjunction with the credentialing application for all Behavioral Health Professionals with the exception of TRICARE Behavioral Health Professionals. Note: TRICARE Behavioral Health Professionals will need to complete and submit the form below.
Behavioral Health Form/TRICARE – required to be submitted in conjunction with the credentialing application for all TRICARE Behavioral Health Professionals.
Hospital Referral Letter – required to be submitted in conjunction with the credentialing application for those providers who do not have admitting privileges at a network hospital.
Contract/Agreement - To request for a contract/agreement to be sent to you from BCBSTX, complete the online request form or contact your local Professional Provider Network office.

Forward fully completed application packet to:

Fax to: 972-996-8230 (preferred method)

or

Mail to:
Blue Cross and Blue Shield of Texas
Provider Administration
P.O. Box 650267
Dallas, TX 75265-0267

*The licensing board for Psychologists (PhDs) does not provide a quick verification method of a provider's license. PhDs will be fully credentialed and made effective after credentialing approval.

Revised 07/2009