Network Participation



Print



You can join the BCBSTX provider network in four easy steps:

  • Step 1Get set up.

    Before you can join the BCBSTX Provider Networks, you will need to be assigned a BCBSTX Provider Record ID. To get set up, go to Request a BCBSTX Provider Record ID.

    Note: You must obtain a BCBSTX Provider Record ID before moving to Step 2.

  • Step 2 — Get contracted.

    Complete the BCBSTX Contract/Agreement Network Participation Online Request Form.

    Note to Primary Care Physicians: Prior to moving on to Step 3 — Get credentialed — you must have an open office location where a site visit can be performed.

  • Step 3 — Get credentialed.

    Once you have been notified by BCBSTX of your assigned Provider Record ID, you will need to be credentialed. Go first to one of the following (whichever applies):

  • Step 4 — Get connected.

    Participation in all electronic options available to BCBSTX physicians and other professional providers is strongly encouraged.

    Electronic data interchange (EDI) transactions help to ensure timeliness, accuracy and security of claims-related information. EDI transactions include:

    • Availity®  (for electronic claim submission and other functions)
    • Electronic Funds Transfer (EFT)
    • Electronic Remittance Advice (ERA)
    • Electronic Payment Summary (EPS)
    • Electronic Refund Management (eRM)

    For details on how to sign up for these electronic solutions visit the Electronic Commerce area on the BCBSTX Provider website.

Other Important Information

We would like to provide you with more information about becoming a participating provider for BCBSTX. Please check out the following:


Prior to claim submission, rendering providers must request and obtain a BCBSTX Provider Record ID for claim payment. The Provider Record ID associates the provider’s rendering NPI with their billing NPI and Tax Identification Number.

Note: Obtaining a BCBSTX Provider Record ID does not automatically activate the BlueChoice PPO/POS or HMO Blue Texas networks. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.

  • If you do not already have a Provider Record ID established with BCBSTX that matches your billing information (Rendering NPI, Billing NPI and TIN), you will need to complete one of the provider record information packets below (Solo or Group).
  • If you need the status of a previously submitted Provider Record ID Information Form Packet or have questions regarding the completion of the Provider Record ID Information Form Packet, you will need to contact Provider Administration at 972-996-9610.
  • Once you have received notice of your established Provider Record ID and would like to be a participating network provider, you will need to continue with How to Join BCBSTX Provider Networks - Step 2 – Get contracted.

Solo Provider Record ID Information Form Packet  should be completed by:

  • A provider who will not be employing another professional provider
  • A provider who will be using his/her social security number for tax purposes
  • A provider whose Tax Identification Number (TIN) is legally filed under the provider’s name
  • A provider who is not incorporated

Group Provider Record ID Information Form Packet  should be completed by:

  • A provider who has a practice with more than one professional provider
  • A provider whose Federal Tax ID has a corporate legal name
  • A provider if the billing entity is incorporated
  • An existing group adding a new provider only needs to complete and submit the Group Member Information Form on page 3 of the Group Provider Record ID Information Form Packet. Note: An existing group does not need to complete and submit the entire packet.

Forward completed Provider Record Form Packet to BCBSTX:

Fax to: 972-996-8445 (preferred method)

or

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



Provider Rights: Applicants applying or reapplying for participation or continued participation in the Health Plan networks have the right to be informed of the following:

  • Right to review information submitted on or with their credentialing and recredentialing application;
  • Right to correct erroneous information;
  • Right to be informed of the status of their credentialing or recredentialing application, upon request.

Applicants should direct all requests to their local Professional Provider Network office. The Enterprise Credentialing Department will notify the Applicant in writing if erroneous information is discovered during the verification process from any primary source. Applicants will be given sufficient time to correct erroneous information and resubmit to the Enterprise Credentialing Department.  It will be the Applicant’s responsibility to work directly with the reporting entity(ies) to correct the erroneous information.

BCBSTX requires full credentialing of the following office based physicians and other professional providers* for participation in their managed care networks:

  • 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
  • Registered Dieticians

*An applicant in a training program is not eligible to be considered for network participation.

Expedited Credentialing Process

BCBSTX will provide an expedited credentialing process which allows for a "provisional network participation" status if the provider applicant:

  • has a valid BCBSTX Provider Record ID for claim payment
  • has submitted a current signed BCBSTX contract/agreement
  • completes the CAQH UPD database online application with "global" or "plan specific" authorization to BCBSTX (or if applicable, submits a completed TDI application)
  • has a valid license in the state by, and in good standing with, the Texas Licensing Boards.

Important:

  • If the applicant does not meet the "provisional network participation" requirements, the applicant must be fully credentialed and approved prior to being made effective.
  • 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.
  • Please allow for a sufficient period of time for the full credentialing process to be completed, before calling BCBSTX for a status update, as credentialing is a very involved and timely process.

Initial Credentialing and Recredentialing Process

BCBSTX requires physicians and other professional providers to use the Council for Affordable Quality Healthcare's (CAQH®*) Universal Provider Datasource (UPD®) for initial credentialing and recredentialing. UPD, a free online service, allows physicians and other professional providers to fill out one application to meet the credentialing data needs of multiple organizations. The UPD database online credentialing application process supports our administrative simplification and paper reduction efforts. This solution also supports quality initiatives and helps to ensure the accuracy and integrity of our provider database. Providers will be able to utilize the UPD database at no cost.

Texas physicians and other professional providers who have a provider type listed in the CAQH Approved Provider Types list below must apply for initial or continuing participation with BCBSTX through the UPD database by accessing the CAQH website. Go to Getting Started with CAQH.

CAQH Approved Provider Types

CAQH will only accept providers who have a provider type on their approved provider types list:

CAQH Approved Provider Types

Standard Provider Types

Medical Doctor (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), Doctor of Podiatric Medicine (DPM), Doctor of Chiropractics (DC), Doctor of Osteopathy (DO)

Allied Provider Types

Acupuncturist (ACU), Audiologist (AUD), Biofeedback Technician (BT), Alcohol/Drug Counselor (ADC), Christian Science Practitioner (CSP), Clinical Nurse Specialist (CNS), Clinical Psychologist (CP), Clinical Social Worker (CSW), Professional Counselor (PC), Licensed Practical Nurse (LPN), Massage Therapist (MT), Marriage/Family Therapist (MFT), Naturopath (ND), Neuropsychologist (NEU), Midwife (MW), Nurse Midwife (NMW), Nurse Practitioner (NP), Nutritionist (LN), Occupational Therapist (OT), Optometrist (OD), Optician (DT), Physicial Therapist (PT), Registered Dietician (RD), Registered Nurse (RN), Certified Registered Nurse Anesthetist (CRNA), Registered Nurse First Assistant (RNFA), Respiratory Therapist (RT), Speech Pathologist (SLP)


Exceptions:

  1. BCBSTX's requirement of use of the CAQH UPD database does not apply to physicians and other professional providers participating through delegated credentialing agreements/contracts or are solely practicing in a hospital based environment.
  2. Texas physicians and other professional providers who do not have a provider type listed in the above CAQH Approved Provider Types list must go to the TDI website  to access and complete a Texas Standardized Credentialing Application, and fax or mail to BCBSTX the completed application along with the required supporting documents referenced below:
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Controlled and Dangerous Substances (DPS) Certificate
    • Malpractice insurance face sheet
    • Summary of any pending or settled malpractice case(s) - if within 10 or less years old
    • Curriculum Vitae
    • Signed Attestation (page 18 of online application – print and sign)
    • Written Protocol (Nurse Practitioners only)

Additional Forms Required by BCBSTX for Credentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete the form(s) and forward to BCBSTX:

Forward completed application packet to BCBSTX:

Fax to: 972-996-8230 (preferred method)
or
Mail to:
Blue Cross and Blue Shield of Texas
Attn: Provider Administration
P.O. Box 65067
Dallas, TX 75265-0267


CAQH Approved Provider Types

CAQH will only accept providers who have a provider type on their approved provider types list:

CAQH Approved Provider Types

Standard Provider Types

Medical Doctor (MD), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), Doctor of Podiatric Medicine (DPM), Doctor of Chiropractics (DC), Doctor of Osteopathy (DO)

Allied Provider Types

Acupuncturist (ACU), Audiologist (AUD), Biofeedback Technician (BT), Alcohol/Drug Counselor (ADC), Christian Science Practitioner (CSP), Clinical Nurse Specialist (CNS), Clinical Psychologist (CP), Clinical Social Worker (CSW), Professional Counselor (PC), Licensed Practical Nurse (LPN), Massage Therapist (MT), Marriage/Family Therapist (MFT), Naturopath (ND), Neuropsychologist (NEU), Midwife (MW), Nurse Midwife (NMW), Nurse Practitioner (NP), Nutritionist (LN), Occupational Therapist (OT), Optometrist (OD), Optician (DT), Physicial Therapist (PT), Registered Dietician (RD), Registered Nurse (RN), Certified Registered Nurse Anesthetist (CRNA), Registered Nurse First Assistant (RNFA), Respiratory Therapist (RT), Speech Pathologist (SLP)

 

Important:

Providers who have a Provider Type listed in the CAQH Approved Provider Types list above:


Providers who do not have a Provider Type listed in the CAQH Approved Provider Types list above:

  1. Visit the TDI website  to access a Texas Standardized Credentialing Application.
  2. After completing the application, please gather the following required supporting documents:
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Controlled and Dangerous Substances (DPS) Certificate
    • Malpractice insurance face sheet
    • Summary of any pending or settled malpractice case(s) — if within 10 or less years old
    • Curriculum Vitae
    • Signed Attestation (page 18 of online application — print and sign)
    • Written Protocol (Nurse Practitioners only)
  3. Additional Forms Required by BCBSTX for Credentialing
    If you are a physician or other professional provider, review the following list for any additional forms applicable to your facility. Complete necessary forms and include them in your collection of credentialing documents to be mailed to BCBSTX:

  4. Forward completed credentialing application packet to BCBSTX:

    • Fax 972-996-8230 (preferred method)
    • OR
    • Mail
      Blue Cross and Blue Shield of Texas
      Attn: Provider Administration
      P.O. Box 65067
      Dallas, TX 75265-0267

Activating Your Universal Provider Datasource (UPD) Registration With CAQH

BlueChoice and HMO Blue Texas participating physicians and other professional providers must have a CAQH Provider ID to register and begin the credentialing process.

First Time Users (If you are not registered with CAQH)

  1. Once you obtain a BCBSTX Provider Record ID and submit a current signed BCBSTX contract/agreement to BCBSTX, BCBSTX will add your name to its roster with CAQH.
  2. CAQH will then mail you access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the CAQH UPD database via the Internet.
  3. When you receive your CAQH Provider ID:
    1. go to the CAQH website  to register, or
    2. physicians and other professional providers who do not have internet access may submit their application via fax to CAQH by first contacting the CAQH Help Desk at 888-599-1771.
  4. After successfully authenticating key information you will be able to create your own user name and unique password to begin using the UPD database.

Note: Registration and completion of the online application is free.


Existing Users

  1. If you have already registered your CAQH Provider ID and completed your UPD online application through your participation with another health plan, log into the CAQH UPD database and add BCBSTX as one of the health plans that can access your information.
  2. To authorize BCBSTX to access your data — follow these four (4) easy steps:
    1. Go to upd.cagh.org . Under Providers, select GO TO UNIVERSAL PROVIDER DATASOURCE, then enter your username and password
    2. Click the Authorize tab (located under the CAQH logo)
    3. Scroll down, locate BCBSTX, and check the box beside BCBSTX, or you may select "global authorization"
    4. Click Save to submit your changes

Completing the Application Process

The CAQH UPD standardized application is a single, standard online form that meets the needs of all participating health care organizations. When completing the application, you will need to indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the UPD service is maintained by CAQH in a secure, state-of-the-art data center.

Reference Materials for Completing the UPD Online Application

  • Previously completed credentialing application
  • List of previous and current practice locations
  • Various identification numbers (UPIN, NPI, Medicare, Medicaid, etc)
  • State medical license(s)
  • Drug Enforcement Administration (DEA) Certificate
  • Controlled and Dangerous Substances (DPS) Certificate
  • IRS Form W-9(s)
  • Malpractice insurance face sheet
  • Summary of any pending or settled malpractice cases – if within 10 or less years old
  • Curriculum Vitae

Note: When you are ready to begin entering your data, log into the UPD  database with your user name and password.

After completing the online credentialing application, you will also be asked to:

  • Authorize access to your information — Check the box beside BCBSTX, or you may select "global authorization."
  • Verify your data entry/Attest — Review the summary of your data for accuracy and completeness, and make any necessary changes.
  • Submit supporting documents — Fax the applicable documents required to complete your application to CAQH at 866-293-0414.
    • State medical license(s)
    • Drug Enforcement Administration (DEA) Certificate
    • Controlled and Dangerous Substances (DPS) Certificate
    • Malpractice insurance face sheet
    • Summary of any pending or settled malpractice case(s) (if within 10 or less years old)
    • Curriculum Vitae
    • Signed Attestation (page 18 of online application – print and sign)
    • Written Protocol (Nurse Practitioners only)

If you have any questions on accessing the UPD database , you may contact the CAQH Help Desk at 888-599-1771 for assistance.

Note: BCBSTX may contact you to supplement, clarify or confirm certain responses on your application. Therefore, you may be required to submit additional documentation in some situations, in addition to the information you submit through the UPD database.

Additional Resources

Explore the CAQH website  for more information about the CAQH UPD database and the application process. Or you can view the CAQH Provider Credentialing Application  now.

View the CAQH Provider and Practice Administrator Quick Reference Guide 


CAQH Contact Information
Help Desk 888-599-1771
Online Application System 
Help Desk Email Address caqh.uphelp@acsgs.com

6 a.m. – 8 p.m., CT, Monday – Thursday
6 a.m. – 6 p.m., CT, Friday
Fax Supporting
Documentation to:
866-293-0414



The Council for Affordable Quality Healthcare, Inc. (CAQH) is a not-for-profit collaborative alliance of the nation's leading health plans and networks. The mission of CAQH is to improve health care access and quality for patients and reduce administrative requirements for physicians and other health care providers and their office staffs.

CAQH is solely responsible for its products and services, including the Universal Provider Datasource.


For your convenience, we have outlined the steps necessary for facility based providers to submit a request for contracting/participating in the BlueChoice® and/or HMO Blue® Texas networks.

  • Eligible specialties include, but are not limited to, Anesthesia, Emergency Medicine, Radiology, Pathology, Neonatology and Hospitalist.
  • The facility based application only applies to providers who practice exclusively in a facility, either a hospital OR a freestanding outpatient facility.

 

Hospital or Facility Based Providers must have the following:
  • Hospital privileges
  • Type 1 NPI #
  • Texas State Board of Medical Examiners license (temporary permit is acceptable) or appropriate Texas licensure
  • Certificate/AANA# (applicable to CRNA providers only)

Note: A BCBSTX Provider Record ID does not automatically activate the BlueChoice PPO/POS or HMO Blue Texas networks. Claims will be processed out-of-network, until the provider has applied for network participation, been approved and activated in the network.

If provider is …Then …

with a provider group that is currently contracted with the BlueChoice and/or HMO Blue Texas networks.

a solo practitioner or medical group interested in contracting as a facility based provider with the BlueChoice and/or HMO Blue Texas networks.


Keeping your information current with CAQH and BCBSTX is your responsibility.

CAQH UPD Database
You will be sent automatic reminders from CAQH to review and attest to the accuracy of your data. Use the UPD database  to report any changes to your practice.

Note: You must enter your changes into the UPD database for BCBSTX to access during the credentialing and recredentialing process. Only health plans that participate in the UPD database that you have authorized access will receive any changes.

BCBSTX Provider File Updates
BCBSTX members rely on the accuracy of the provider information in our online Provider Finder®. This is why it’s very important that you also inform BCBSTX of changes to your practice. If you are a participating provider with BCBSTX, you may request most changes online by using the online Provider Data Update Notification Form.


The process of recredentialing is identical to that for credentialing, and is consistent with NCQA and State of Texas requirements.

  • If you are an existing user of CAQH, you are required to review and attest to your data once every four (4) months.
  • At the time you are scheduled for recredentialing, BCBSTX will send your name, via its roster, to CAQH to determine if you have already completed the UPD credentialing process and authorized BCBSTX or selected “global authorization”. If so, BCBSTX will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you.
  • If your credentialing application (for recredentialing) is not available to BCBSTX through CAQH because
    1. you have not completed the UPD credentialing process - CAQH will mail you a welcome kit that includes access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the UPD database via the Internet to complete and submit your application,
    2. or
    3. you are a physician or other professional provider who does not have a provider type listed in the CAQH Approved Provider Types list, you must go to the TDI website  to access and complete a Texas Standardized Credentialing Application, and fax or mail the completed application along with the required supporting documents referenced below:
      • State medical license(s)
      • Drug Enforcement Administration (DEA) Certificate
      • Controlled and Dangerous Substances (DPS) Certificate
      • Malpractice insurance face sheet
      • Summary of any pending or settled malpractice case(s) - if within 10 or less years old
      • Curriculum Vitae
      • Signed Attestation (page 18 of online application – print and sign)
      • Written Protocol (Nurse Practitioners only)
  • Forward completed application packet to BCBSTX:

    Fax to: 972-996-8230 (preferred method)
    or
    Mail to:
    Blue Cross and Blue Shield of Texas
    Attn: Provider Administration
    P.O. Box 65067
    Dallas, TX 75265-0267

Additional Forms Required by BCBSTX for Recredentialing

If you are a physician or other professional provider that requires one of the following additional forms listed below, you must complete and forward by fax or mail to BCBSTX as indicated above.