To continue participation with BCBSTX' managed care networks, a fully completed Texas Standardized Credentialing Application packet is required.  Use the TDI Credentialing Application Completion Guide to verify that you 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.

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 

Revised 07/2009